Publications by authors named "Guner Kaya"

39 Publications

Does magnetic resonance imaging increase core body temperature in children? Results of the administration of propofol and ketofol: a randomized clinical study.

Turk J Pediatr 2020 ;62(2):224-232

Departments of Anesthesiology and Reanimation, İstanbul University Cerrahpasa Faculty of Medicine, İstanbul, Turkey.

Background And Objectives: Magnetic resonance imaging (MRI) may cause a temperature increase in the imaging area, while intravenous anesthetics may develop a tendency for hypothermia, especially in the pediatric population. The effect of different anesthetics on core body temperature in children during these procedures remains controversial. We examined the effect of propofol and ketofol on core body temperatures in a pediatric population during MRI. Our hypothesis was that the increase in body temperature will be more prominent in pediatric patients receiving ketofol than in those receiving propofol.

Methods: This was a randomized, prospective, double-blind study in pediatric patients aged 6 months to 10 years. The patients were American Society of Anesthesiologist (ASA) physical class I-II who had undergone MRI under anesthesia at the Cerrahpasa School of Medicine, MRI Area, between August 2014 and February 2016. Patients were assigned to one of two groups: Group I (propofol group) and Group II (ketofol group). MRIs were performed with a 1.5 Tesla (T) device. Bilateral tympanic membrane temperature measurements before and after the procedure were performed.

Results: Body temperature decreased in both groups after MRI. Clinically significant hypothermia or hyperthermia was not observed in any of the patients.

Conclusion: Temperature monitoring is not necessary for every patient being imaged. However, temperature changes should be closely monitored in high-risk patients.
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http://dx.doi.org/10.24953/turkjped.2020.02.008DOI Listing
January 2020

Complications during esophageal endoscopy with or without baloon dilation under general anesthesia in pediatric patients: a prospective and observational study.

Arch Argent Pediatr 2018 Apr;116(2):98-104

Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Background: Complications can occur during esophagoscopy as a result of applied procedure in children, especially during dilation techic. Our aim was to identify cardio-respiratory alterations during esophagoscopy with or without baloon dilation under anesthesia in children, and to investigate the postoperative complications.

Methods: Prospective, observational study of endoscopic procedures in patients 0-16 years. The patients were divided into two groups: the endoscopy-dilation group (Group ED: endoscopy and balloon dilation due to esophageal stricture) and endoscopy without dilation (Group E: endoscopy for diagnostic reasons, control esophagoscopy or sclerotherapy). Hemodynamic and ventilatory parameters alterations and complications during endoscopy, dilation and two-hours follow-up time in the postoperative recovery room were recorded.

Results: 102 procedures in 60 patients were included. Peak inspiratory pressure (PIP) values significantly increased after endoscopy in both groups (p<0.001). There was a significant increase in mean PIP values in the dilation group during the procedure (p<0,001). The difference in PIP values before and after the endoscopy was negatively correlated with age in both groups. When the groups were subdivided taking two years of age as a cut-off point in comparing PIP difference before-after endoscopy, PIP increase was statistically significant in both groups under two-years old. In the dilation group, statistically significant increase of HR was detected during the procedure (p<0,001).

Conclusion: During endoscopy PIP increased in patients with or without baloon dilation especially in the dilation group. PIP increase was higher in younger children. Severe respiratory and cardiovascular complications during balloon dilation under general anesthesia should be carefully observed and managed.
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http://dx.doi.org/10.5546/aap.2018.eng.98DOI Listing
April 2018

Anaesthetic Management of a Child with a Massive Mediastinal Mass.

Turk J Anaesthesiol Reanim 2017 Dec 1;45(6):374-376. Epub 2017 Dec 1.

Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa University School of Medicine, İstanbul, Turkey.

Mediastinal masses are benign or malignant tumours that originate from the thymus, thyroid, lung, lymphoid system, pleura, or pericardium. Cardiovascular and respiratory symptoms may occur because of the compression of surrounding tissues along with growing mass. In this study, we present the anaesthetic management of a 6-month-old child having a massive anterior mediastinal mass that had a compressing effect.
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http://dx.doi.org/10.5152/TJAR.2017.81557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772418PMC
December 2017

Pudendal Nerve Block Versus Penile Nerve Block in Children Undergoing Circumcision.

Urol J 2018 05 3;15(3):109-115. Epub 2018 May 3.

Cerrahpasa Medical Faculty, Department of Anesthesiology and Reanimation, Istanbul, TURKEY.

Purpose: Penile nerve block is the most popular nerve block for the circumcision in pediatric patients. This study aimed to compare the analgesic efficiency of penile nerve block and the pudendal nerve block on postoperative pain and additional analgesic requirements in children undergoing circumcision.

Material And Methods: This prospective randomized double-blind study enrolled 85 children, aged 1 to10 years, undergoing circumcision. The patients were randomly divided into two groups either receiving dorsal penile block group (PNB-Group) or pudendal nerve block (PDB-Group). In the PNB-Group, 0.3 ml/kg 0.25 % bupivacaine was used; and, in the PDB-Group, 0.3 ml/kg bupivacaine was applied with nerve stimulator at a concentration of 0.25%. In the postoperative period, the modified CHEOPS pain scale scoring and additional analgesic demand were evaluated at the 5th and 30th minutes and at the 1st and 2nd hours. The subsequent pain evaluations were made by the parents at home, at the postoperative 6th, 12th, 18th and 24th hours.

Results: Seven patients were excluded from the study, and seventy eight patients were evaluated for analysis. Patients in PDB-Group had significantly lower postoperative pain intensity and lower mCHEOPS scores (3.83 ± 0.98) when compared to the PNB-Group (6.47 ± 0.91) (P < .01) at all measurement times and none of patients in PDB-Group had additional analgesic requirements up to 24 hours. Patients in the PNB-Group had significantly more analgesic requirements at all measurements times except at the 1st, 2nd, 24th hours. 3.8%, 30.8%, 46.2% and 59% of the patients in the PNB group needed additional analgesia respectively at 5th, 6th, 12th and 18th hours.

Conclusion: Pudendal nerve block provided additional analgesic free period and had better analgesic efficiency compared to the penile nerve block lasting until 24 hours after operation.
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http://dx.doi.org/10.22037/uj.v0i0.4292DOI Listing
May 2018

The Assessment of Risk Factors for Difficult Intubation in Thyroid Patients.

World J Surg 2018 06;42(6):1748-1753

Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Genel Cerrahi, 34098, Fatih, Istanbul, Turkey.

Objectives: We aimed to assess possible risk factors related to difficult intubation in patients undergoing thyroid surgery.

Methods: We prospectively collected data of 200 patients scheduled for thyroid surgery. Clinical risk factors were defined as: Mallampati score, interincisor gap, thyromental distance, sternomental distance, range of neck motion, body mass index, neck circumference, goiter, the presence of radiological findings suggesting compression and thyroid weight. All evaluations were performed with Macintosh assessed for Cormack and Lehane (CL) classification and modified intubation difficulty scale (MIDS).

Results: It was observed that the proportion of patients with a thyroid weight ≥40 g, goiter, a Macintosh CL score = 3-4 and the mean neck circumference were significantly higher in the group with a MIDS score >5 (p = 0.018, p = 0.011, p < 0.001, respectively).

Conclusion: The presence of a palpable goiter, thyroid weight ≥40 g and thyromental distance <6.5 cm were risk factors associated with difficult intubation in the multivariate regression model.
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http://dx.doi.org/10.1007/s00268-017-4391-yDOI Listing
June 2018

Accidental intrathecal catheterization in two patients having undergone lumbar radiotherapy.

Agri 2017 10;29(4):191-192

Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Istanbul Turkey.

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http://dx.doi.org/10.5505/agri.2016.50469DOI Listing
October 2017

Laryngotracheal edema due to thermal injury: A complication after thyroidectomy in children.

Arch Argent Pediatr 2017 02;115(1):e31-e33

Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.
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http://dx.doi.org/10.5546/aap.2017.eng.e31DOI Listing
February 2017

Transversus Abdominis Plane (TAP) block for postoperative analgesia in neonates and young infants: retrospective analysis of a case series. TAP blocks in neonates and young infants.

Minerva Anestesiol 2017 03 11;83(3):282 - 287. Epub 2016 Nov 11.

Department of Anesthesia and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey -

Background: The effectiveness of the TAP block in children has been well characterized in literature. However, there are only few reports about TAP block in the neonates and low birth weight groups. This is a retrospective observational analysis of ultrasound - assisted TAP blocks in neonates and young infants. The aim of this study to analyze retrospectively the analgesic effectiveness of TAP block in neonates and infants undergoing abdominal and inguinal surgeries.

Methods: Thirty-four cases of neonates and infants with (whom) applied TAP block were retrospectively analyzed. The TAP block was performed postoperatively in supraumbilical surgeries and preoperatively in infraumbilical surgeries. The TAP block was applied with 0.8 ml/kg-1 of 0.25% bupivacaine in unilateral approach and 1.6 mlkg-1 of 0.125% bupivacaine in bilateral approach. The CRIES Pain Scale was used for postoperative pain measurement of neonates.

Results: The patient's age ranged from 2 to 88 day-old with a mean (SD) of 36.2(24.2). Eleven of them were premature babies. The weight ranged from 1.6 to 5.8 with a mean (SD) of 3.7kg (1.1). Twenty-nine patients were extubated at the end of the surgery and the other patients within 12 hours. 67.7% infants required no additional postoperative analgesic in 24 hours and none of them required narcotic analgesics.

Conclusions: Our conclusion is that the use of TAP blocks results in low analgesic requirements and a low incidence of postoperative intubation and mechanical ventilation in neonates and infants. It should be considered in this age group of child for postoperative analgesia.
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http://dx.doi.org/10.23736/S0375-9393.16.11420-8DOI Listing
March 2017

Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery: A Randomized Controlled Trial.

Reg Anesth Pain Med 2016 Sep-Oct;41(5):610-5

From the Departments of *Anesthesiology and Intensive Care, and †Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Background And Objectives: Postoperative pain management after hypospadias surgery is often challenging. Caudal block is used for analgesia but has limitations. This study compares the analgesic efficiency of pudendal block with that of caudal block in pediatric patients undergoing hypospadias repair surgery.

Methods: This prospective, double-blind, randomized, controlled study enrolled 84 patients receiving pudendal block or caudal block before hypospadias surgery. In the pudendal group, the pudendal nerve was identified using a nerve stimulator, and the block consisted of 0.25% bupivacaine 0.5 mL/kg. In the caudal group, the caudal block used 0.2% bupivacaine 1 mL/kg. Our primary outcome was pain intensity within 24 hours postoperatively. The trial was registered at ClinicalTrials.gov (number: NCT02390388).

Results: For the primary outcome, patients in the pudendal group had lower postoperative pain intensity when compared with the caudal group (P < 0.001). Three patients in the pudendal group and all of the patients in the caudal group needed additional analgesia within 24 hours after the surgery (P < 0.001). The family satisfaction rate was significantly higher in the pudendal group (P < 0.001).

Conclusions: For the pudendal group, the pain scores for the first 24 hours after the surgery were significantly lower and the duration of analgesia was longer.
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http://dx.doi.org/10.1097/AAP.0000000000000447DOI Listing
March 2017

Anaesthetic Management of a Patient with Synchronous Kartagener Syndrome and Biliary Atresia.

Turk J Anaesthesiol Reanim 2015 Jun 16;43(3):205-8. Epub 2015 Feb 16.

Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Kartagener syndrome is an autosomal recessive disorder characterized by primary ciliary dyskinesia accompanied by sinusitis, bronchiectasis, and situs inversus. Synchronous extrahepatic biliary atresia and Kartagener syndrome are very rare. During the preoperative preparation of patients with Kartagener syndrome, special attention is required for the respiratory and cardiovascular system. It is important to provide suitable anaesthetic management to avoid problems because of ciliary dysfunction in the perioperative period. Further, maintaining an effective pain control with regional anaesthetic methods reduces the risk of pulmonary complications. Infants with biliary atresia operated earlier have a higher chance of survival. Hepatic dysfunction and decrease in plasma proteins are important for the kinetics of drugs. In this presentation, the anaesthetic management of patients with synchronous Kartagener syndrome and biliary atresia, both of which are rare diseases, is evaluated.
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http://dx.doi.org/10.5152/TJAR.2015.94546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917192PMC
June 2015

Anaphylaxis after administration of amikacin containing sodium metabisulfite in a premature newborn.

Arch Argent Pediatr 2016 Jun 1;114(3):e195-8. Epub 2016 Jun 1.

Department of Anesthesiology and Intensive Care, Cerrahpasa Medical School, İstanbul Üniversitesi, Istanbul, Turkey.

Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can cause death. Premature newborns, whose immunological system is immature, are less likely to develop anaphylaxis. Administration of amikacin, containing sodium metabisulfite, to a 3-day-old premature newborn, induced a near fatal anaphylaxis. After suspicion of sepsis, the baby was started on amikacin. Clinical improvement was observed after initiation of treatment. On the third day of treatment with amikacin, the newborn suddenly developed tachypnea, tachycardia, angioedema and cyanosis. Anaphylaxis was diagnosed and treated. Latent reaction occurred after one hour of clinical improvement. The baby was intubated immediately. Anaphylaxis is a medical emergency; therefore the clinicians should have a rapid and careful assessment about this potentially fatal reaction. Even after successful treatment of anaphylaxis, the patient should be under observation for 72 hours because of the possibility of a biphasic reaction.
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http://dx.doi.org/10.5546/aap.2016.eng.e195DOI Listing
June 2016

Emergency bronchoscopy for foreign-body aspiration in a child with type I mucopolysaccharidosis: a challenging airway management experience.

J Anesth 2016 08 4;30(4):696-8. Epub 2016 May 4.

Department of Anesthesiology and Intensive Care, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Fatih, 34098, Istanbul, Turkey.

The mucopolysaccharidosis (MPS) is a rare lysosomal storage disease. Glycosaminoglycans (GAG) accumulate in musculoskeletal system, connective tissues. Enlarged tongue, short immobile neck, and limited mobility of the cervical spine and temporomandibular joints render the airway management potentially risky. MPS children have high anesthetic risks, especially in airway management of emergency situations. The foreign-body aspiration requiring intervention with rigid bronchoscopy is an urgent and risky clinical situation. We present our experience with a challenging airway management with a three-year-old child with MPS who needed emergency bronchoscopy due to peanut aspiration.
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http://dx.doi.org/10.1007/s00540-016-2180-7DOI Listing
August 2016

Ultrasound-assisted transversus abdominis plane block vs wound infiltration in pediatric patient with inguinal hernia: randomized controlled trial.

J Clin Anesth 2016 May 17;30:9-14. Epub 2016 Feb 17.

Department of Anesthesiology and Reanimation, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey. Electronic address:

Study Objective: To compare the analgesic efficacy of ultrasound-assisted transversus abdominis plane (TAP) block and wound infiltration during the first postoperative 24hours.

Design: A prospective, observer-blinded, randomized, and controlled study

Setting: Operating room of a university hospital.

Patients: Forty patients received a TAP block (TAP group) and 40 patients received wound infiltration (INF group) at the end of the surgery.

Interventions: Patients were randomized to receive a TAP block or wound infiltration. Postoperative analgesics were administered on request and selected based on pain severity.

Measurements: Pain scores, analgesic drug requirement, and side effects were observed for 24hours.

Main Results: Postoperative pain scores were lower in TAP group compared to INF group (P<.001). Analgesic consumption was significantly higher at the 5th minute and 1st, 6th, and 12th hours in the INF group (P<.001). The frequency of additional analgesic use in home and the total analgesic used during the postoperative 24hours were significantly higher in INF group (P<.001). Side effects were lower in the TAP group. Parent's satisfaction scores were higher in TAP group.

Conclusion: Transversus abdominis plane block is effective method with convenient technique, drug dosage, and volume in pediatric patients undergoing inguinal hernia surgery.
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http://dx.doi.org/10.1016/j.jclinane.2015.12.027DOI Listing
May 2016

Sugammadex usage in a patient with dermatomyositis.

J Clin Anesth 2015 Aug 22;27(5):438-9. Epub 2015 Apr 22.

Department of Anesthesiology and Reanimation, Cerrahpasa Medical School, Istanbul University, Kocamustafapasa, Fatih, 34098, Istanbul, Turkiye. Electronic address:

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http://dx.doi.org/10.1016/j.jclinane.2015.03.011DOI Listing
August 2015

Comparison of Transversus Abdominis Plane Block and IV Patient-Controlled Analgesia after Lower Abdominal Surgery.

Turk J Anaesthesiol Reanim 2015 Feb 9;43(1):24-8. Epub 2014 Dec 9.

Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Objective: We aimed to compare the first 24-hour postoperative analgesic efficiency of ultrasound (USG)-assisted transversus abdominis plane (TAP) block to IV morphine patient-controlled analgesia (PCA) in patients undergoing lower abdominal surgery.

Methods: Fifty ASA I-III patients were included into this randomised, prospective clinical study. At end of surgery, Group 1 received 1 mg kg(-1) 0.5% bupivacaine and 1 mg kg(-1) 1% lidocaine in a 30-mL volume during TAP-block. Group 2 received 1 mg kg(-1) tramadol IV 10 minutes before extubation, and PCA was started with 1 mL morphine IV at a concentration of 1 mg kg(-1) and a 10-min lock time. Visual analogue scale (VAS), heart rate (HR), respiratory rate, peripheral oxygen saturation (SpO2), additional analgesic need and nausea-vomiting at the postoperative 30(th) minute and 1, 2, 3, 6, 12, and 24 hours were evaluated. In both groups, when VAS values were >4, patients were given 1 mg kg(-1) tramadol IV in first evaluation at the 30(th) minute or 15 mg kg(-1) paracetamol at other evaluations.

Results: No difference was observed between groups in terms of VAS values. No difference was observed in terms of HR in the within-group comparison, but Group 1 HR values were lower compared to Group 2 (p<0.01). No difference was observed in additional analgesic need at any times. Nausea-vomiting score was higher in Group 2 in the between-group comparison at the 30(th) minute (p<0.04), but no difference was observed after the 1(st) hour.

Conclusion: Transversus abdominis plane block is effective as IV morphine-PCA in postoperative pain therapy in lower abdominal surgery, when given in a 30-mL volume. It may be preferable to IV-PCA, as the analgesic effect starts earlier and decreases the systemic effect of the morphine used in PCA.
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http://dx.doi.org/10.5152/TJAR.2014.82788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917121PMC
February 2015

Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine.

Clinics (Sao Paulo) 2014 Jun;69(6):372-7

Department of Anesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Objective: Laryngoscopy and stimuli inside the trachea cause an intense sympatho-adrenal response. Remifentanil seems to be the optimal opioid for rigid bronchoscopy due to its potent and short-acting properties. The purpose of this study was to compare bolus propofol and ketamine as an adjuvant to remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy.

Materials And Methods: Forty children under 12 years of age who had been scheduled for a rigid bronchoscopy were included in this study. After midazolam premedication, a 1 µg/kg/min remifentanil infusion was started, and patients were randomly allocated to receive either propofol (Group P) or ketamine (Group K) as well as mivacurium for muscle relaxation. Anesthesia was maintained with a 1 µg/kg/min remifentanil infusion and bolus doses of propofol or ketamine. After the rigid bronchoscopy, 0.05 µg/kg/min of remifentanil was maintained until extubation. Hemodynamic parameters, emergence characteristics, and adverse events were evaluated.

Results: The demographic variables were comparable between the two groups. The decrease in mean arterial pressure from baseline values to the lowest values during rigid bronchoscopy was greater in Group P (p = 0.049), while the reduction in the other parameters and the incidence of adverse events were comparable between the two groups. The need for assisted or controlled mask ventilation after extubation was higher in Group K.

Conclusion: Remifentanil-based total intravenous anesthesia with propofol or ketamine as an adjuvant drug along with controlled ventilation is a viable technique for pediatric rigid bronchoscopy. Ketamine does not provide a definite advantage over propofol with respect to hemodynamic stability during rigid bronchoscopy, while propofol seems more suitable during the recovery period.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050329PMC
http://dx.doi.org/10.6061/clinics/2014(06)01DOI Listing
June 2014

Effects of different modes of ventilation and head position on the size of the vena jugularis interna.

Swiss Med Wkly 2014 7;144:w13946. Epub 2014 May 7.

Istanbul University Cerrahpasa Medical Faculty, Department of Anaesthesiology and Reanimation, Fatih, Turkey.

Purpose: Right internal jugular vein (RIJV) catheterisation is a common procedure in patients undergoing surgery. We aimed to compare diameters and the cross-sectional area (CSA) of the RIJV when the head is in a neutral or 30-degree rotated position during mechanical ventilation in various modes and spontaneous ventilation.

Methods: Thirty patients undergoing surgery were included in the study. In each patient, still ultrasound images of the vena jugularis interna were taken with the head in a neutral position and with the neck rotated 30 degrees to the left, first under spontaneous ventilation (group S), then after the induction of anaesthesia under volume-controlled ventilation (group V) and under pressure-controlled ventilation (group P). The six still images were evaluated in terms of transverse and anteroposterior diameters and CSA.

Results: Diameters in the neutral and lateral positions in group S were significantly smaller than in group P and group V (neutral transverse p = 0.01, anteroposterior p = 0.041, rotated transverse p = 0.01, anteroposterior p = 0.03). The CSAs of the RIJV in the neutral and lateral positions were significantly larger in group P and group V than Group S (lateral CSA p = 0.001, neutral CSA p = 0.002). CSA increased significantly only in group P when the head was rotated 30 degrees laterally (p = 0.002).

Conclusion: We conclude that both pressure-controlled and volume-controlled mechanical ventilation have similar effects on the CSA and diameters of the RIJV. Positioning of the head with a 30-degree rotation laterally has different effects on CSA depending on the ventilation mode used. A neutral position should be preferred with spontaneous ventilation whereas 30 degree rotation should be preferred in patients under pressure-controlled and volume-controlled ventilation.
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http://dx.doi.org/10.4414/smw.2014.13946DOI Listing
September 2014

Comparison of the Effects of Different Concentrations of Rocuronium on Injection Pain and Hemodynamics Using Isolated Forearm Technique.

Turk J Anaesthesiol Reanim 2013 Oct 23;41(5):162-6. Epub 2013 May 23.

Department of Anaesthesiology and Reanimation, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey.

Objective: We aimed to evaluate Visual-Analogue-Scale (VAS) scores, hand-withdrawal, rash and skin eruptions after injections of different concentrations of rocuronium in intubation doses in alert patients using the isolated-forearm technique.

Methods: Eighty ASA I-II patients were included in a randomized, controlled, single-blinded study. Two 20 G cannulas were inserted into the dorsum of the left and right hand in each patient. A tourniquet was applied to the left arm and inflated to 50 mm Hg above the patient's systolic blood pressure. Group 1 (n=20) received 2.5 mg mL(-1) rocuronium diluted with 0.9% NaCl, Group 2 (n=20) received 5 mg mL(-1) rocuronium diluted with 0.9% NaCl, Group 3 (n=20) received 10 mg mL(-1) rocuronium and 0.4 mg mL(-1) lidocaine mixture, and Group 4 (n=20) received 10 mg mL(-1) rocuronium via a cannula on the left hand, provided that a dose of 0.6 mg mL(-1) were given to all groups of patients. VAS0-VAS60 values, hand-withdrawal, rash and skin eruptions were assessed in patients who were administered rocuronium but not under the effects of hypnotic or neuromuscular agents. Hemodynamic values were recorded both before and after the administration of hypnotic-neuromuscular agents.

Results: VAS0 values were significantly higher in Group 4 when compared to Groups 1, 2 and 3 (p=0.032). No significant difference was observed between VAS0 and VAS60 values in Groups 1, 2 and 3. In Group 4, VAS0 values were significantly higher than VAS60 values (p=0.003). No significant difference was observed between groups in terms of side effects and hemodynamic values.

Conclusion: In conclusion, we determined that using rocuronium diluted with 0.9% NaCl was more effective in preventing injection pain than using a rocuronium-lidocaine mixture.
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http://dx.doi.org/10.5152/TJAR.2013.35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894091PMC
October 2013

A comparison of the TruView EVO2 and macintosh laryngoscope blades.

Clinics (Sao Paulo) 2011 ;66(4):709-11

Department of Anesthesiology, Cerrahpasa Medical Faculty, Istanbul University, Turkey.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093804PMC
http://dx.doi.org/10.1590/s1807-59322011000400029DOI Listing
December 2011

Restoration of pulmonary compliance after laparoscopic surgery using a simple alveolar recruitment maneuver.

J Clin Anesth 2009 Sep;21(6):422-6

Department of Anesthesiology and Reanimation, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey.

Study Objective: To test the hypothesis that a pulmonary maneuver designed to recruit additional alveoli (thereby decreasing atelectasis) applied before extubation can restore pulmonary compliance to baseline values.

Design: Cohort study.

Setting: Operating room of a university hospital.

Patients: 20 ASA physical status I and II patients scheduled to undergo laparoscopic radical nephrectomy.

Interventions: Participants received a balanced general anesthesia using intermittent positive pressure ventilation. A pulmonary recruitment maneuver was performed as a single manual inflation of the lungs to 40 cm H(2)O, maintained for 10 seconds after release of pneumoperitoneum.

Measurements: Respiratory mechanics including dynamic compliance were measured continuously using the VenTrak respiratory mechanics monitor (VenTrak; Novametrix, Wallingford, CT, USA). Respiratory measures were recorded together with arterial blood gases after induction (T1), with the patient placed in the lateral "jackknife" position (T2), 10 and 120 minutes after CO(2) insufflation (T3 and T4), immediately after desufflation in the lateral and supine positions (T5 and T6), and 10 minutes after a pulmonary recruitment maneuver at the conclusion of surgery (T7). Outcome data were analyzed using analysis of variance for repeated measures; P < 0.05 was defined as statistically significant.

Main Results: On average, compliance decreased from an initial value of 63.5 to 52.6 mL/cm H(2)O when patients were turned from the supine to the lateral position (T1 vs. T2; P < 0.001), and decreased further to 31.07 mL/cm H(2)O after CO(2) insufflation (T2 vs. T3; P < 0.001). Compliance increased to 50.8 mL/cm H(2)O after desufflation and 54.4 mL/cm H(2)O after turning the patient to the supine position, but did not return to baseline levels until after performance of the pulmonary recruitment maneuver, 64.3 mL/cm H(2)O (T6 vs. T7; P < 0.001, and T1 vs. T7; P = 0.73).

Conclusions: Respiratory mechanics do not fully return to baseline levels after desufflation following laparoscopy; however, lung compliance can be fully restored using a simple alveolar recruitment maneuver.
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http://dx.doi.org/10.1016/j.jclinane.2009.08.001DOI Listing
September 2009

Evaluation of intravenous paracetamol administration on postoperative pain and recovery characteristics in patients undergoing laparoscopic cholecystectomy.

Surg Laparosc Endosc Percutan Tech 2009 Aug;19(4):321-3

Department of Anesthesiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.

Purpose: In this study, the effects of intravenous paracetamol treatment on early postoperative period analgesia and recovery characteristics after laparoscopic cholecystectomy have been evaluated.

Methods: Forty patients whose American Society of Anesthesiologists physical status I or II underwent laparoscopic cholecystectomy and randomly divided into 2 equal groups. In the first group, 1 g paracetamol was given to the patients intravenously after intubation before start of the surgery in 15 minutes. The 100 mL 0.9% NaCl was infused intravenously for the control group in 15 minutes. Postoperative pain was evaluated and recovery characteristics were evaluated.

Results: Verbal and visual pain scores of the paracetamol group were significantly lower than control group (P<0.05). First morphine requirement and total administered morphine dose and duration of staying in recovery room were significantly decreased in the paracetamol group (P<0.05).

Conclusions: Beside its effective analgesic properties, paracetamol administration during per operative period supports effective and faster recovery.
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http://dx.doi.org/10.1097/SLE.0b013e3181b13933DOI Listing
August 2009

Anesthesia in children with epidermolysis bullosa.

Plast Reconstr Surg 2008 Jul;122(1):34e-35e

Department of Anesthesiology and Reanimation (Cakmakkaya, Altindas, Kaya) Department of Plastic, Reconstructive, and Aesthetic Surgery; Cerrahpasa Medical Faculty; University of Istanbul; Istanbul, Turkey (Baghaki).

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http://dx.doi.org/10.1097/PRS.0b013e3181774722DOI Listing
July 2008

Management of esophageal perforation secondary to caustic esophageal injury in children.

Surg Today 2008 27;38(4):311-5. Epub 2008 Mar 27.

Department of Pediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University, Atakoy, Istanbul, Turkey.

Purpose: To review our management of esophageal perforation in children with caustic esophageal injury.

Method: We reviewed the medical records of 22 children treated for esophageal perforations that occurred secondary to caustic esophageal injury.

Results: There were 18 boys and 4 girls (mean age, 5 years; range, 2-12 years). Three children were treated for perforation during diagnostic endoscopy and 19 were treated for a collective 21 episodes of perforation during balloon dilatation. One child died after undergoing emergency surgery for tracheoesophageal fistula and pneumoperitoneum. Another patient underwent esophagostomy and gastrostomy. Twenty patients were treated conservatively with a nasogastric tube, broad spectrum antibiotics, and tube thoracostomy, 16 of whom responded but 4 required esophagostomy and gastrostomy. Although the perforation healed in 21 patients, 20 were left with a stricture. Two children were lost to follow-up, 8 underwent colonic interposition, and 10 continued to receive periodic balloon dilatations. Two of these 10 patients underwent colonic interposition after a second perforation. The other 8 became resistant to dilatations: 4 were treated by colon interposition; 2, by resection and anastomosis; and 2, by an esophageal stent.

Conclusions: Esophageal perforation can be managed conservatively. Because strictures tend to become resistant to balloon dilatation, resection and anastomosis is preferred if they are up to 1 cm in length, otherwise colonic interposition is indicated.
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http://dx.doi.org/10.1007/s00595-007-3638-xDOI Listing
August 2008

Detection of epithelial cell transfer in spinal areas by light microscopy and determining any tissue coring via cell culture during combined spinal-epidural interventions.

Reg Anesth Pain Med 2006 Nov-Dec;31(6):539-45

Department of Anesthesiology and Reanimation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

Background And Objectives: Epithelial tissue coring by spinal needles during subarachnoid injections may cause intraspinal epidermal tumors. Previous studies have investigated tissue transfer with different needle types during subarachnoid or epidural injection. This study deals with the transfer of epithelial tissue during combined spinal-epidural (CSE) anesthesia.

Methods: We studied 68 American Society of Anesthesiologists I to III adult patients. CSE anesthesia was induced under aseptic conditions at the L2-3 or L3-4 interspace with patients in the lateral decubitus position. Cerebral spinal fluid, spinal needle stylet, fluid used to flush the interior of the spinal needle, fluid used to wash the exterior of the spinal needle, fluid used to flush the interior of the epidural needle, and fluid used to wash the exterior tip of the epidural needle were examined under light microscopy (n = 30 patients) or incubated in a cell-culture medium (n = 38 patients). Samples were incubated in cell-culture medium alone (n = 13) or in a cell-culture medium for 3 weeks and then in a medium with epidermal growth factor (n = 25). As a positive control, skin tissue samples were taken by punch biopsy from 10 randomly chosen patients who underwent CSE interventions. These samples were incubated in an enriched medium serum.

Results: Light microscopy revealed that there was cell transfer in all phases in various rates: samples 1, 2, 3, 4, 5, and 6 contained epithelial cells and debris in ratios of 6.9%, 20.7%, 6.9%, 20.7%, 26.7%, and 33.3%, respectively. Epithelial cell colonization was detected in the cell-culture samples taken from the control group but not in the samples taken from the CSE group.

Conclusions: We could not reproduce the cells or cell debris obtained during the CSE interventions in vivo, which can be explained by a possible structural deformation of cells or the inadequacy of the amount of cells that were transferred.
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http://dx.doi.org/10.1016/j.rapm.2006.06.251DOI Listing
February 2007

Anesthesia management with short acting agents for bilateral pheochromocytoma removal in a 12-year-old boy.

Paediatr Anaesth 2006 Nov;16(11):1184-8

Cerrahpasa Medical Faculty, Department of Anesthesiology and Reanimation, Istanbul University, Istanbul, Turkey.

A 12-year-old boy with bilateral adrenal pheochromocytoma pretreated with furosemide, nifedipine, prazosin, and propranolol underwent surgical removal of the tumors. General anesthesia with desflurane, remifentanil infusion and thoracic epidural analgesia was performed. To control the blood pressure (BP), remifentanil up to 1 microg.kg(-1).min(-1) infusion rate, sodium nitroprusside, and esmolol infusions were administered successfully. Following the ligation of the adrenal veins, hemodynamic parameters were stable and neither inotropic support nor corticosteroid replacement was required. We concluded that remifentanil-based anesthesia combined with low-dose desflurane and thoracic epidural analgesia may reduce the need for vasoactive drugs in the anesthesia management of pheochromocytoma. This combination may not prevent the hemodynamic fluctuations during tumor manipulation, but appears to facilitate a rapid and stable postoperative recovery.
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http://dx.doi.org/10.1111/j.1460-9592.2006.01979.xDOI Listing
November 2006

Association of the C677T and A1298C polymorphisms of methylenetetrahydrofolate reductase gene with schizophrenia: association is significant in men but not in women.

Prog Neuropsychopharmacol Biol Psychiatry 2005 Sep;29(7):1113-23

Department of Medical Biology and Genetics, Faculty of Medicine, University of Kocaeli, Derince, 41900, Kocaeli, Turkey.

Schizophrenia is a complex and common psychiatric disorder with a polygenic inheritance. In our previous report, we showed an association between the methylenetetrahydrofolate reductase (MTHFR) gene C677T and A1298C polymorphisms and schizophrenia in patients from Bakirkoy in Istanbul, Turkey [Sazci, A., Ergul, E., Guzelhan, Y., Kaya, G., Kara, I., 2003. Methylenetetrahydrofolate reductase gene polymorphisms in patients with schizophrenia. Mol. Brain Res. 117, 104-107]. We wanted also independently to confirm this study in a gender-specific manner with schizophrenic patients from Erenkoy in Istanbul, Turkey. To investigate the role of the C677T and A1298C polymorphisms of methylenetetrahydrofolate reductase gene in schizophrenia in a gender-specific manner, we analyzed the genotypes of MTHFR677 and MTHFR1298 of 297 schizophrenic patients and 341 healthy controls, using a polymerase chain reaction restriction fragment length polymorphism method. The MTHFR 677T allele was significantly distributed (chi2=7.312; P=0.026), between schizophrenic patients and healthy controls. The T677T genotype was overrepresented in the total schizophrenic patients (OR=1.938; 95%CI=1.133-3.315; chi2=5.996; P=0.014). Similarly, the T677T/A1298A compound genotype was the most significant one in the total schizophrenic patients (OR=2.397; 95% CI=1.327-4.330; chi2=8.821; P=0.003). The C1298C genotype was overrepresented in the total schizophrenic patients (OR=1.706; 95%CI=1.014-2.870; chi2=4.126; P=0.042). Likewise, the C677C/C1298C compound genotype was significant in the total schizophrenic patients (OR=1.689; 95%CI=0.985-2.894; chi2=3.695; P=0.055). When schizophrenic patients and healthy controls were stratified according to gender difference, the T677T genotype and T677T/A1298A compound genotype were significantly overrepresented (OR=2.184; 95% CI=1.069-4.462; chi2=4.767; P=0.029; OR=2.748; 95% CI=1.215-6.214; chi2=6.301; P=0.012, respectively) in men schizophrenic patients. However, neither the MTHFR C677T nor the A1298C polymorphisms are associated with schizophrenia in women. In conclusion, the MTHFR 677T allele and T677T, C1298C genotypes, and T677T/A1298A, C677C/C1298C compound genotypes are genetic risk factors for schizophrenia in men but not in women in a gender-specific manner.
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http://dx.doi.org/10.1016/j.pnpbp.2005.06.022DOI Listing
September 2005