Publications by authors named "Seda Banu Akinci"

18 Publications

  • Page 1 of 1

Stroke Mechanism in COVID-19 Infection: A Prospective Case-Control Study.

J Stroke Cerebrovasc Dis 2021 Aug 1;30(8):105919. Epub 2021 Jun 1.

Department of Neurology, Hacettepe University Hospitals Turkey.

Background: The characteristics and pathophysiological mechanisms involved in acute ischemic stroke in patients with COVID-19 infection have not been fully clarified. We prospectively studied the phenotypic and etiological features of acute stroke occurring in COVID-19 infection.

Patients & Methods: Within nine months starting from April-2020, the presence of COVID-19 infection was determined by thoracic CT and SARS-CoV-2 PCR in all acute stroke cases managed in a single tertiary center. Consecutive and prospective data on vascular risk factors/comorbidities, in-hospital quality metrics, discharge outcomes, etiological subclassification and blood markers of thrombosis / inflammation were compared in 44 COVID-19 positive cases (37 acute ischemic stroke, 5 TIA, 2 intracerebral hematoma) and 509 COVID-19 negative patients (355 ischemic, 105 TIA, 44 hematoma and 5 stroke mimic).

Results: COVID-19 positive patients had more severe strokes, delayed hospital admission, longer hospital stay, higher mortality rates, but had similar vascular risk factors/comorbidities frequency, thrombolysis/thrombectomy utilization rates, metrics, and stroke etiological subtype. They had significantly higher CRP, fibrinogen, ferritin, leukocyte count and lower lymphocyte count. No difference was detected in aPTT, INR, D-dimer, platelet, hemoglobin, homocysteine levels and ANA, anti-dsDNA antibody and ENA panel positivity rates. Anti-phospholipid antibodies have been studied in 70% of COVID-19 positive and all cryptogenic patients, but were never found positive. Tests for coagulation factor levels and hereditary thrombophilia did not show major thrombophilia in any of the stroke patients with COVID-19.

Conclusion: We documented that there is no significant difference in etiological spectrum in acute stroke patients with COVID-19 infection. In addition, cryptogenic stroke and antiphospholipid antibody positivity rates did not increase.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166511PMC
August 2021

Maternal Mortality: 10 Year Experience of a Tertiary Center in Turkey.

Case Rep Med 2020 30;2020:3595024. Epub 2020 Sep 30.

Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey.

We retrospectively evaluated five maternal mortality cases that occurred in our institution within the last 10 years. Rate of maternal mortality was 24.5 per 100000 live births. Maternal mortality causes were cardiopulmonary failure secondary to veno-occlusive disease, septic shock secondary to osteosarcoma, pulmonary thromboembolism secondary to metastatic breast cancer, septic shock secondary to cholecystitis, and postpartum hemorrhage secondary to Niemann-Pick disease. Four out of five cases were evaluated as indirect maternal mortality cases. Three out of five cases ended up with a healthy newborn, while other cases ended up with abortus and postpartum exitus.
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http://dx.doi.org/10.1155/2020/3595024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545441PMC
September 2020

Characteristics of obstetric admissions to intensive care unit: APACHE II, SOFA and the Glasgow Coma Scale.

J Perinat Med 2019 Nov;47(9):947-957

Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Sıhhiye, Ankara, Turkey.

Objective To evaluate the characteristics of obstetric admissions to an intensive care unit (ICU) and assess the utility of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and the Glasgow Coma Scale (GCS). Methods This study is consisted of 160 patients admitted to an ICU during the antenatal period or within 7 days at the postpartum period. Clinical characteristics and ICU scores were evaluated. Results The rate of admission to the ICU was 7.8/1000 deliveries. Four cases ended with maternal mortality (2.5%). The most common hospitalization indications were hypertensive disorders of pregnancy, cardiovascular disorders and obstetric hemorrhage, at 40 (25%), 34 (21.2%), and 31 (19.3%) cases, respectively. The receiver operating characteristics (ROC) curve analysis for prediction of maternal mortality revealed area under curve (AUC) values as 0.971 both for APACHE II and predicted mortality rate (PMR), and 24.5 and 47.1 were determined as the cut-offs with sensitivities of 100%. AUCs were also 0.901 and 0.929 for the initial and worst SOFA score, respectively. The cut-off value for the initial and worst SOFA score was 3.5, with a sensitivity of 100%, and was 10 with a specificity of 98.9%, respectively. Conclusion APACHE II and PMR overpredict maternal mortality, but those higher scores predict maternal mortality. Higher SOFA scores are related with maternal mortalities with high specificity.
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http://dx.doi.org/10.1515/jpm-2019-0125DOI Listing
November 2019

Fatal Postpartum Hemorrhage in a Patient with Niemann-Pick Disease Type B.

Case Rep Obstet Gynecol 2018 28;2018:9719374. Epub 2018 Jun 28.

Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey.

Background: Niemann-Pick Disease Type B (NPD B) is a rare lysosomal storage disorder resulting from an inherited deficiency of acid sphingomyelinase activity. Here, we report the case of a splenectomized patient with NPD B who died because of severe postpartum hemorrhage (PPH).

Case Presentation: A 23-year-old nulliparous woman was admitted to intensive care unit (ICU) after cardiopulmonary arrest during urgent hysterectomy because of severe postpartum bleeding. The patient concealed her disease from her family and obstetricians during her pregnancy, and her NPD B diagnosis was revealed during her stay in ICU while searching for the cause of the splenectomy and severe bleeding. Unfortunately, she had a detrimental course with hypoxic brain injury leading to brain death.

Conclusions: In conclusion, physicians should keep in mind that patients with a history of splenectomy and/or uncontrollable hemorrhage must be carefully evaluated for rare diseases like lysosomal storage diseases and that NPD B can cause mortality because of postpartum bleeding. Adult intensivists should be familiar with adult presentations of rare metabolic or genetic diseases as more and more children with metabolic or genetic diseases will survive to adulthood and will be admitted to and unfortunately will even die in the adult ICU.
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http://dx.doi.org/10.1155/2018/9719374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6046142PMC
June 2018

Evaluation of stressors in intensive care units.

Turk J Surg 2018 4;34(1):5-8. Epub 2018 Jan 4.

Department of General Surgery, Hacettepe University School of Medicine, Ankara, Turkey.

Objective: Physical and psychological stressors adversely affect the treatment and length of stay of patients in intensive care units. In this study, we aimed to describe environmental and psychological stressors affecting intensive care unit patients and to determine their priorities.

Material And Methods: In this study, the 40-item Intensive Care Unit Environmental Stressor Scale was administered to patients in the General Surgery Intensive Care Unit and the Anesthesiology and Reanimation Intensive Care Unit. The patients' age, gender, marital status, educational status, cause of hospitalization, and intensive care unit length of stay were questioned and recorded. Acute Physiology And Chronic Health Evaluation II scores were determined for intensive care unit patients.

Results: A total of 98 patients, 80 in the General Surgery Intensive Care Unit and 18 in the Anesthesiology and Reanimation Intensive Care Unit, were included in the study between May 1, 2015 and October 31, 2015. Fifty-six of the patients were male (57.1%) and 42 were female (42.9%). The mean age of the patients was 55.1±15.1 years. The mean intensive care unit length of stay was 3.4±1.6 days. The median Acute Physiology And Chronic Health Evaluation II score of the patients was 6 (0 to 17). The patients were most affected by thirst (mean 2.44). The second most stressful stress factor was the presence of tubes in the mouth and nose (mean 2.25). The least stressful factor for the patients was the presence of nurses constantly performing activities around the bed. Although 51% of the patients were postoperative, pain was ranked 5th among stress factors.

Conclusion: The environmental and psychological factors affecting intensive care unit patients varied according to age, sex, and educational and surgical status. These factors had adverse effects on the patients. The elimination or modification of these factors would contribute positively to the treatment of intensive care unit patients and shorten their length of stay in the intensive care unit.
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http://dx.doi.org/10.5152/turkjsurg.2017.3736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937660PMC
January 2018

Increased heart rate on first day in Intensive Care Unit is associated with increased mortality.

Pak J Med Sci 2016 Nov-Dec;32(6):1402-1407

Prof. Dr. Ulku Aypar, Anesthesiology and Reanimation Unit, Hacettepe University Medical Faculty, Ankara, Turkey.

Objective: To investigate the association of maximum HR during the first day of intensive care unit (ICU) and mortality.

Methods: Data of 850 patients over 45 years of age, who were hospitalized in ICU, was retrospectively analyzed. They were divided into two groups; Group-I, patients with maximum HR<100/min Group-II, patients with maximum HR≥100/min on first day. The groups were compared regarding age, sex, use of beta-blockers, use of inotropic and vasopressor drugs, hemodynamic parameters, anemia, mechanical ventilation, length of hospitalization (ICU and total), mortality (ICU and total), and CHARLSON & APACHE-II scores.

Results: The mean age of patients was 63±12 years and 86% were after non-cardiac surgery. Maximum HR was 83±11 in Group-I and 115±14/min in Group-II (p=0.002). Group-II patients had more frequent vasopressor and inotropic drugs usage, (p<0.001), anemia, mechanical ventilation (p<0.005), higher CHARLSON & APACHE-II scores, stayed longer in ICU and hospital, and had higher ICU and hospital mortality compared to group-I (p<0.05). APACHE-II scores and maximum HR<100/min were independent variables predicting ICU mortality in multivariate logistic regression analysis whereas usage of beta-blockers was not.

Conclusions: Our study showed that maximum HR less than100/minute during the first day of ICU is associated with decreased mortality in Intensive Care Unit.
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http://dx.doi.org/10.12669/pjms.326.11507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216290PMC
January 2017

[Progressive hematoma in anterior neck after endovascular treatment of middle cerebral artery aneurysm].

Braz J Anesthesiol 2018 Mar - Apr;68(2):194-196. Epub 2016 Dec 23.

Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turquia.

Background: Cervical hematomas can lead to airway compromise, a life threatening condition, regardless of the cause. The following case is the first presentation of cervical hematoma as a complication of endovascular treatment of middle cerebral artery aneurysm.

Case Report: A 49 year-old woman was scheduled for stent placement under general anesthesia for middle cerebral artery aneurysm. Few days before intervention, acetyl salicylic acid and clopidogrel treatment was started. Following standard monitoring and anesthesia induction, the patient's trachea was intubated with a 7.5mm endotracheal tube and the procedure was completed without any complications. Three hours later, dyspnea developed and physical examination revealed progressive swelling and stiffness in the neck. Endotracheal intubation was performed with a 6mm diameter uncuffed tube with the aid of sedation. The vocal cords were completely closed due to compression. There was no leak around the endotracheal tube. The rapidly performed computerized tomography scans showed an enormous hematoma around the neck and extravasation of contrast medium through superior thyroid artery. After coil embolization of superior thyroid artery, she was taken to the intensive care unit as intubated and sedated. Surgical exploration of the hematoma was not recommended by the surgeons, because she was on clopidogrel. After two days, the patient's trachea was extubated safely ensuring that the swelling was sufficiently ceased and leak detected around the endotracheal tube.

Conclusions: Securing the airway rapidly by endotracheal intubation is the most crucial point in the management of cervical hematomas. Diagnostic and therapeutic procedures should be performed only afterwards.
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http://dx.doi.org/10.1016/j.bjan.2016.12.003DOI Listing
May 2019

Comparison of intraarticular bupivacaine and levobupivacaine injection in rat synovial inflammation.

Turk J Med Sci 2014 ;44(4):540-5

Department of Anesthesia and Reanimation, Atatürk Education and Research Hospital, Ankara, Turkey.

Background/aim: Both bupivacaine and levobupivacaine are local anesthetics with strong analgesic efficacy that can be used intraarticularly. The aim of this study was to compare the effects of intraarticular bupivacaine and levobupivacaine injection on inflammation in articular cartilage and the synovium of the rat knee joint.

Materials And Methods: Twenty Sprague-Dawley rats were injected in the right knee joint with 0.2 mL of bupivacaine, while 0.2 mL of levobupivacaine was injected into the left knee joint. Groups of 5 were sacrificed on days 1, 7, 14, and 21 after bupivacaine and levobupivacaine administration and knee joints were examined for subintimal fibrosis, synovial hyperplasia, chronic inflammation, neutrophil infiltration, edema, and synovial and periarticular congestion by microscopy. Alterations in the articular cartilage structure were evaluated using Mankin scoring.

Results: We found that both drugs have similar effects on synovial and articular cartilage resulting in mild to moderate congestion, edema, neutrophil infiltration, chronic inflammation, and synovial hyperplasia, which diminished gradually. However, increases in fibrosis were also seen to varying degrees. Thus, the use of these drugs intraarticularly can be recommended.

Conclusion: Careful usage of bupivacaine and levobupivacaine is recommended in intraarticular applications since they cause inflammation shortly after injection and fibrosis at later time points.
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http://dx.doi.org/10.3906/sag-1302-32DOI Listing
January 2015

Comments on Pérez-Bárcena et al.: a randomized trial of intravenous glutamine supplementation in trauma ICU patients.

Intensive Care Med 2014 Sep 6;40(9):1396. Epub 2014 Aug 6.

Hacettepe University Medical School Intensive Care Unit Sıhhiye, Ankara, Turkey,

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http://dx.doi.org/10.1007/s00134-014-3401-xDOI Listing
September 2014

The Effect of Different End-tidal Desflurane Concentrations on Bispectral Index Values in Normal Children and Children with Cerebral Palsy.

Turk J Anaesthesiol Reanim 2013 Dec 23;41(6):200-5. Epub 2013 May 23.

Department of Anaesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Objective: In this study, we aimed to compare the effects of different intraoperative end-tidal desflurane concentrations on bispectral index (BIS) values in normal children and children with cerebral palsy.

Methods: Twenty normal children (Group N) and 20 children with non-communicative/nonverbal cerebral palsy (Group CP), between 2 and 15 years of age, undergoing elective orthopaedic surgery were included in the study. Following premedication with midazolam, anaesthesia was induced by infusing 1% propofol at a rate of 200 mL hr(-1) until BIS reached 50. Heart rate, blood pressure and BIS values were recorded before and after the induction of anaesthesia, at steady-state end-tidal concentrations of 4% and 6% desflurane, and after emergence from anaesthesia. A p value <0.05 was considered significant in the statistical analyses, including Kolmogorov-Smirnov, t-test, paired samples t-test and chi-square test.

Results: The time to extubation and eye opening after discontinuation of anaesthesia was longer in Group CP. BIS values before the induction of anaesthesia, at a steady-state end-tidal desflurane concentration of 4% and after emergence from the anaesthetic were significantly lower in Group CP. At a steady-state end-tidal desflurane concentration of 6%, BIS values were slightly lower in Group CP but this difference was not statistically significant.

Conclusion: Based on the data obtained, we concluded that BIS monitoring in children with cerebral palsy can be useful in terms of decreasing adverse effects and drug interactions due to multiple drug usage by reducing the use of anaesthetic agents and improving emergence from the anaesthetic.
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http://dx.doi.org/10.5152/TJAR.2013.33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894209PMC
December 2013

Pain on injection of propofol: a comparison of methylene blue and lidocaine.

J Clin Anesth 2011 Jun;23(4):270-4

Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, TR-06100, Turkey.

Study Objective: To investigate whether methylene blue, given before injection of propofol, was effective in reducing the frequency and severity of pain associated with propofol injection.

Design: Prospective, randomized, double-blinded clinical study.

Setting: Operating room of a university hospital.

Patients: 90 adult, ASA physical status 1 and 2 patients undergoing elective surgery.

Interventions: Patients were randomly allocated to one of three groups of 30 patients each. Group I received 50 mg of methylene blue, Group II received 40 mg of lidocaine, and Group III, the control group, was given normal saline. All drugs were given as a 2.0 mL bolus 45 seconds before propofol administration.

Measurements: Injection pain using vocal responses, facial grimacing, arm withdrawal, tears, and questioning of the patient were noted. A 4-point scale was used for documenting pain.

Main Results: Pain frequency was 90% in the saline group, whereas the frequencies were significantly lower in the lidocaine and methylene blue groups (26.7% and 40%, respectively).

Conclusions: Intravenous pretreatment with methylene blue appears to be effective in reducing the pain during propofol injection.
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http://dx.doi.org/10.1016/j.jclinane.2010.09.008DOI Listing
June 2011

[Entrapment of a Swan-Ganz catheter within the right pulmonary artery ligature during right pneumonectomy].

Tuberk Toraks 2009 ;57(1):81-3

Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Entrapment of a pulmonary artery catheter in the pulmonary artery is a rare and severe complication that may lead to fatal complications such as pulmonary artery injury. We describe entrapment of a Swan-Ganz catheter within the right pulmonary artery ligature in a patient undergoing right pneumonectomy. This situation resulted with removal of catheter safely without any complication. We concluded that with early recognition of the complication during thoracotomy, is golden standard in preventing pulmonary artery catheter entrapment and surgeons should be aware of the risk of accidentally transfixing pulmonary artery catheter in every type of operation that takes place in thorax.
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October 2009

The efficacy of ketamine for the treatment of postoperative shivering.

Anesth Analg 2008 Jan;106(1):120-2, table of contents

Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey.

Background: There are few reports on the utility of ketamine for the prevention of postoperative shivering. We thus established the efficacy of two doses of ketamine compared with meperidine for the treatment of postoperative shivering.

Methods: This is a prospective, randomized double-blind study involving 90 ASA I-II patients after general anesthesia. Patients with shivering grade 3-4 were allocated to receive either meperidine 25 mg, ketamine 0.5 mg/kg, or ketamine 0.75 mg/kg IV. Shivering and side effects were monitored at set time intervals.

Results: Shivering grades for the first 4 min after treatment were lower in the ketamine groups; however, nystagmus and feeling like "walking in space" was experienced with both doses of ketamine.

Conclusion: Ketamine 0.5-0.75 mg/kg is more rapid than meperidine (25 mg) for the reduction of postoperative shivering, but the side effect profile may limit its usefulness.
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http://dx.doi.org/10.1213/01.ane.0000296458.16313.7cDOI Listing
January 2008

Heat shock protein 60 antibody. A new marker for subsequent atrial fibrillation development.

Saudi Med J 2007 Jun;28(6):844-7

Department of Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.

Objective: To examined the pre- and post- operative anti-HSP60 antibodies of serum from patients in preoperative sinus rhythm.

Methods: We prospectively studied 45 consecutive patients admitted for elective CABG from 2004 to 2005. We randomly selected 10 patients developing AF (study sample [Group A]) and 10 postoperative patients without AF (control [Group B]. The study took place at the Department of Cardiovascular Surgery, Hacettepe University, Ankara, Turkey.

Results: Anti-HSP60 IgG value was 27.76 +/- 12.69 absorbance units (AU) in Group A preoperatively and decreased to 13.73 +/- 5.51 AU postoperatively. Controversially, preoperative value of anti-HSP60 IgG was 9.94 +/- 2.92 AU and decreased to 6.72 +/- 1.89 AU, postoperatively in Group B. Statistical analysis showed significant difference regarding preoperative anti-HSP60 IgG levels in Group A compared to Group B, which might be interpreted as an association between postoperative AF and preoperative levels of anti-HSP60 IgG.

Conclusion: We provide the first evidence demonstrating the association of pre- and post- operative circulating anti-HSP60 antibodies with postoperative AF. These results suggest that serum HSP60 antibody levels may be a marker for subsequent development of AF.
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June 2007

The effects of isoflurane, sevoflurane, and desflurane anesthesia on neurocognitive outcome after cardiac surgery: a pilot study.

Heart Surg Forum 2007 ;10(1):E36-41

Department of Anesthesiology and Reanimation, Hacettepe University, Ankara, Turkey.

Background: Inhalation anesthetics such as isoflurane, sevoflurane, and desflurane are widely used in clinical practice; however, there is no study for comparing these drugs in cardiac surgery with respect to postoperative cognitive outcome and S100 beta protein (S100 BP) levels. In this study, we evaluated the effect of sevoflurane, isoflurane, and desflurane anesthesia on neuropsychological outcome and S100 BP levels in patients undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB).

Materials And Methods: Forty-two male patients were prospectively randomized and classified into 3 groups according to the volatile agents used; isoflurane, sevoflurane, desflurane. All patients had a sufficient education level to participate in neuropsychological testing and a normal carotid Doppler ultrasonography. Blood samples for analysis of S100 BP were collected before anesthesia (T1), before heparinization (T2), 15 minutes into CPB (T3), following protamine administration (T4), postoperatively (T5), 24 hours after the operation (T6), postoperative day 3 (T7), and postoperative day 6 (T8). The neuropsychological tests, including Mini-Mental State Examination (MMSET) and visual-aural digit span test (VADST), were administered 1 day prior to surgery and on the third and sixth postoperative days.

Results: The postoperative third and sixth day MMSET scores and third day visual-written subtest scores in the sevoflurane group were significantly lower than in the isoflurane and desflurane groups (P < .05). S100 BP levels increased with the beginning of anesthesia in the sevoflurane and desflurane groups. Although S100 BP decreased to baseline levels on postoperative day 1 in the sevoflurane group, this was significantly higher on the third and sixth days postoperatively in the desflurane group (P < .05). In the isoflurane group, the S100 BP level was significantly higher than the baseline level only after CPB (P < .05).

Conclusion: Our study suggests that isoflurane is associated with better neurocognitive functions than desflurane or sevoflurane after on-pump CABG. Sevoflurane seems to be associated with the worst cognitive outcome as assessed by neuropsychologic tests, and prolonged brain injury as detected by high S100 BP levels was seen with desflurane.
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http://dx.doi.org/10.1532/HSF98.20061076DOI Listing
December 2006

The effect of halothane, isoflurane, sevoflurane and propofol infusion on renal function after coronary artery bypass surgery.

Middle East J Anaesthesiol 2006 Jun;18(5):955-64

Hacettepe University, Department of Anesthesia and Reanimation, Ankara, Turkey.

Renal insufficiency after cardiac surgery is associated with increased mortality, morbidity, and length of stay in the intensive care unit. We investigated the effect of isoflurane, halothane, sevoflurane and propofol anesthesia on perioperative renal function following elective coronary artery surgery. The medical records of 224 patients, in the Hacettepe University Medical Faculty Hospital who had undergone cardiac surgery in one year, were retrospectively reviewed. 65 (29%) patients received isoflurane, 68 (30%) patients received halothane, 64 (29%) patients received sevoflurane, and 27 (12%) patients received propofol infusion as part of maintenance anesthesia for coronary artery bypass surgery. Patient characteristics (age, sex, preoperative ejection fraction), operative data (duration of CPB, duration of operation, number of distal anastomoses, usage of diuretic, intraoperative crystalloid and blood transfusion), intraoperative urinary output, preoperative and postoperative (6th hours and 24th hours) BUN and plasma creatinine levels, were not statistically significant between and within groups. Intraoperative inotropic agent (dopamine) was used in 8 (12.3%) patients in the isoflurane group, in 10 (14.7%) patients in the halothane group, in 11 (17.2%) patients in sevoflurane group and in 9 (33.3%) patients in the propofol group. Postoperatively fluid and blood transfusion, postoperative drainage, urinary output, diuretic usage were smiliar between the four groups (p>0,05). Inotropic agent was used in 8 (12.3%) patients in the isoflurane group, in 9 (13.2%) patients in the halothane group, in 16 (25%) patients in the sevoflurane group and in 7 (25.9%) patients in the propofol group. It is concluded that, halothane, isoflurane, sevoflurane and propofol infusion anesthesia as part of anesthesia maintenance for elective coronary artery bypass surgery does not affect early postoperative renal functions.
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June 2006

Remifentanil versus fentanyl for short-term analgesia-based sedation in mechanically ventilated postoperative children.

Paediatr Anaesth 2005 Oct;15(10):870-8

Department of Anaesthesiology and Reanimation, Hacettepe University, Ankara, Turkey.

Background: Analgesia-based sedation techniques are becoming more established in the intensive care unit (ICU) setting. The aim of this study was to compare remifentanil and fentanyl infusions for postoperative analgesia in pediatric ICU patients.

Methods: After receiving ethical committee approval, a prospective randomized, double-blind study was performed. Twenty-two postoperative orthopedic surgery patients received either remifentanil 0.1 microg.kg(-1).min(-1) or fentanyl 0.025 microg.kg(-1).min(-1) infusions diluted to the same volume. Analgesic infusion was titrated to predefined levels of analgesia [behavioral pain scale (BPS) score of 3]. Propofol was added if sedation was unsatisfactory after BPS score 3 had been achieved.

Results: There were no differences in groups regarding demographics, tracheal extubation times, and pain scores of the patients. After cessation of the opioid infusion, the sedation scores and the heart rates were always higher in the remifentanil group compared with the fentanyl group. The incidences of nausea, vomiting, apnea, desaturation, reintubation within 24 h and constipation were also similar between the two groups.

Conclusions: We conclude that a remifentanil infusion provides clinically comparable analgesia with a fentanyl infusion in mechanically ventilated postoperative pediatric patients. These two drugs are suitable for short-term analgesia-based sedation in pediatric postoperative ICU patients.
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http://dx.doi.org/10.1111/j.1460-9592.2005.01574.xDOI Listing
October 2005

[The effect of day and night shift working on the attention and anxiety levels of anesthesia residents].

Turk Psikiyatri Derg 2005 ;16(2):106-12

Hacettepe U Tip Fak., Ankara.

Objective: To evaluate the attention, learning and memory related cognitive functions after 12-hour day versus night shift-work in anaesthesia residents.

Method: Fifteen residents working on the day shift and 18 working on the night shift volunteered. All were interviewed with the Rey Auditory Verbal Learning Test (AVLT), Visual Aural Digit Span Test (VADST), and State Trait Anxiety Inventory (STAI) before and after the shifts. Residents' self-evaluations of their fatigue, stress, sleep quality and duration of sleep were sought.

Results: The two groups were similar regarding age, gender, attention, fatigue, stress, affection, sleep quality and duration of sleep. The number of words learned in the first trial of the Rey AVLT decreased after the shifts in both groups. Before the night shift the word list could be learned more effectively and with fewer trials compared to the pre-day shift. The learning deteriorated, and repetitions and forgotten words increased after the night shift. The aural oral, aural written and visual written subtest scores deteriorated after the night shift. State anxiety levels did not differ between the night and day shift groups or before and after the shifts.

Conclusion: The cognitive functions of residents may be impaired after the night shift. We think that close supervision of residents and provision of more rest for them during night shifts would be beneficial in decreasing their errors, which may affect patients.
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July 2005
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