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    Öğe
    6-Month Results of Transdiscal Biacuplasty on Patients with Discogenic Low Back Pain: Preliminary Findings
    (Ivyspring Int Publ, 2011) Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Kaya, Sedat; Yildirim, Zeynep Baysal; Uysal, Ersin; Celik, Feyzi
    Study Design: Prospective observational study. Objective: Our aim is to investigate the efficacy and safety of TransDiscal Biacuplasty. Summary of Background Data: Chronic discogenic pain is one of the leading causes of low back pain; however, the condition is not helped by most non-invasive methods. The results of major surgical operations for these patients are unsatisfactory. Recently, attention has shifted to disk heating methods for treatment. TransDiscal Biacuplasty is one of the minimally invasive treatment methods. The method was developed as an alternative to spinal surgical practices and Intradiscal Electrothermal Therapy for treatment of patients with chronic discogenic pain. Methods: The candidates for this study were patients with chronic discogenic pain that did not res pond to conservative treatment. The main criteria for inclusion were: the existence of axial low back pain present for 6 months; disc degeneration or internal disc disruption at a minimum of one level, and maximum of two levels, in MR imaging; and positive discography. Physical function was assessed using the Oswestry Disability Index when measuring the pain with VAS. Patient satisfaction was evaluated using a 4-grade scale. Follow-ups were made 1, 3, and 6 months after treatment. Results: 15 patients were treated at one or two levels. The mean patient age was 43.1 +/- 9.2 years. We found the mean symptom duration to be 40.5 +/- 45.7 months. At the sixth month, 57.1% of patients reported a 50% or more reduction in pain, while 78.6% of patients reported a reduction of at least two points in their VAS values. In the final check, 78.6% of patients reported a 10-point improvement in their Oswestry Disability scores compared to the initial values. No complications were observed in any of the patients. Conclusions: TransDiscal Biacuplasty is an effective and safe method.
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    Öğe
    Airway management for occipital encephalocele in neonatal patients: A review of 17 cases
    (Medknow Publications & Media Pvt Ltd, 2011) Yildirim, Zeynep Baysal; Avci, Emel; Torun, Fuat; Cengiz, Mustafa; Cigdem, Ali; Karabag, Hamza; Karaman, Haktan
    Introduction: Encephalocele, midline defect of cranial bone fusion, occurs most frequently in the occipital region. Airway management in pediatric patients with craniofacial disorders poses many challenges to the anesthesiologist. The purpose of this study is to describe the airway problems encountered for such cases, and describe how these problems were managed. Materials and Methods: We reviewed the charts of occipital encephalocele newborn that were treated by surgical correction in Harran University Hospital during 2006-2008. The collected data were categorized into preoperative, intraoperative, and postoperative data. Results: The mean age of the patients was 5.17 days. Of these 17 patients, eight patients (47.1%) had hydrocephaly, one patient (5.8%) with Dandy Walker syndrome. Micrognathia, macroglossia, restriction in neck movements were recorded as the reasons in six cases each. No major anesthetic complication was found. Conclusions: We reported perioperative management in 17 occipital encephalocele infant. Comprehensive care during peroperative period is essential for successful outcome.
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    Öğe
    Alt ekstremite cerrahisinde spinal anestezi ve kombine femoral-siyatik sinir bloğunun karşılaştırılması
    (2014) Doğan, Erdal; Tüfek, Adnan; Tokgöz, Orhan; Çelik, Feyzi; Karaman, Haktan; Ölmez, Gönül Kavak; Yıldırım, Zeynep B.
    Amaç: Bu çalışmada, alt ekstremite cerrahisi geçiren hastalarda spinal anestezi tekniği ile kombine-siyatik femoral blok (KSFB) tekniklerini karşılaştırmayı amaçladık.Yöntemler: Bu çalışmaya elektif alt ekstremite operasyonu planlanmış, ASA 1-2 grubu, 18-65 yaşları arasındaki 60 hasta dahil edildi. Çalışma prospektif, randomize ve kontrollü olarak planlandı. Hastalar rastgele olarak spinal anestezi uygulanan grup (Grup S) ve kombine siyatik-femoral sinir bloğu (Grup KSFB) gurubu olmak üzere 2 gruba ayrıldı. Bulgular: Demografik veriler açısından gruplar arasında istatistiksel olarak anlamlı fark saptanmamıştır (p>0.05). Tekniğin uygulanma süresi açısından karşılaştırıldığında; KSFB grubunda istatistiksel olarak anlamlı uzun bulundu (p< 0.001). Cerrahiye teslim etme süresi açısından karşılaştırıldığında; Grup S de istatistiksel olarak anlamlı derecede kısa bulundu (p< 0.001). Total motor blok oluşma zamanı açısından karşılaştırıldığında; Grup KSFB'de istatistiksel olarak anlamlı derecede uzun bulundu (p< 0.001). Motor blok süresi açısından karşılaştırıldığında; Grup KSFB'de istatistiksel olarak anlamlı uzun bulundu (p< 0.001).Sonuç: Ortopedik alt ekstremite cerrahi girişimlerinde her iki yöntemin de etkili ve güvenli olduğu, fakat periferik sinir bloğu uygulamasının postoperatif dönemde uzun süreli analjezi sağlama ve postoperatif analjezik tüketimini azaltma gibi önemli avantajları olabilir.
  • Küçük Resim
    Öğe
    Alt ekstremite cerrahisinde uygulanan kombine femoral siyatik sinir bloğu deneyimlerimiz
    (Modestum Publishing Ltd., 2011) Çelik, Feyzi; Tüfek, Adnan; Yıldırım, Zeynep Baysal; Tokgöz, Orhan; Karaman, Haktan; Alemdar, Celil; Atiç, Ramazan; Çiftçi, Taner; Kavak, Gönül Ölmez
    Amaç: Bu çalışmada alt ekstremite cerrahisinde uygulanan kombine femoral - siyatik sinir bloğunun etkinliğinin araştırılması amaçlandı. Gereç ve yöntem: Alt ekstremite cerrahisi geçiren, ASA I-III grubu, 18-70 yaş arası kombine femoral - siyatik sinir bloğu uygulanmış hastalar retrospektif olarak incelendi. Çalışmaya 110 hasta dahil edildi. Hastalar kullanılan lokal anestezik ilaçlara göre dört gruba ayrıldı. Grup I: 30 ml %0.5 Bupivakain + 10 ml %0.9 NaCl, Grup II: 30 ml %0.5 Levobupivakain + 10 ml %0.9 NaCl, Grup III: 30 ml %0.5 Levobupivakain + 10 ml %2 Prilokain HCl, Grup IV: 20 ml %0.5 Bupivakain + 20 ml %2 Prilokain HCl. Hastaların demografik özellikleri, klinik tanıları, kullanılan lokal anestezik dozu ve volümü, tekniğin uygulanma süresi ve cerrahi sure, blok başarı oranları, girişim öncesi ve sonrası hemodinamik parametreler, postoperatif ilk analjezik ihtiyaç zamanı ve postoperatif ilk 24 saatlik analjezik tüketim miktarı, işlem esnasında ve sonrasında gelişen komplikasyonlar, hasta ve cerrahi memnuniyet verileri kaydedildi. Bulgular: Hastaların demografik özellikleri benzer bulundu. Cerrahi anestezi ve postoperatif analjezi kalitesi açısından gruplar arasında farklılık bulunmadı. En sık ayak bileği cerrahisi nedeni ile kombine femoral - siyatik sinir bloğu uygulanmıştı. Hastalara uygulanan faklı doz lokal anesteziklerle yeterli anestezi sağladığı görüldü. İşlem başarısı %96 olarak bulundu. Sonuç: Alt ekstremite cerrahisinde uygulanan kombine femoral - siyatik sinir bloğunun %96 başarıyla uygulandığı, yeterli düzeyde anestezi oluşturduğu ve postoperatif dönemde ortalama 426 dk analjezi sağladığı görüldü.
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    Anorektal cerrahide intratekal kullanılan levobupivakain ve bupivakainin etkinliğinin karşılaştırılması
    (2012) Tüfek, Adnan; Yıldırım, B. Zeynep; Doğan, Erdal; Çelik, Feyzi; Kavak, Ö. Gönül; Karaman, Haktan; Göksu, Hüseyin
    Amaç: Anorektal cerrahide spinal anestezi yaygın olarak uygulanmaktadır. Bu çalışmada fentanil eklenmiş levobupivakain ve bupivakainin anorektal cerrahi geçirecek hastalarda anestezik etkiliği ve hemodinamik parametreler üzerine etkilerinin karşılaştırılması amaçlandı. Gereç ve yöntem: Dicle üniversitesi tıp fakültesi etik kurul onayı ve hastaların yazılı onamları alındıktan sonra anorektal cerrahi geçirecek yaşları 18- 65 arası ASA I-II, 60 hasta çalışmaya dahil edildi. Hastalar rastgele iki gruba ayrıldı. Grup I’e 9 mg % 0,5 bupivakain + 20 mcg fentanil, Grup II’ye 9 mg % 0.5 levobupivakain + 10 mcg fentanil verildi. Spinal anestezi 26G spinal iğne ile L4-5 lomber aralıktan girilerek sağlandı. Hastalarda duyusal blok seviyesi pin-prick test ile motor blok seviyesi ise Bromage skalası ile değerlendirildi ve hemodinamik veriler kaydedildi. Bulgular: Sensoriyel blok başlangıç sürelerinde ve iki segment gerileme zamanları açısından gruplar arasında istatistiksel olarak anlamlı fark bulunmadı. Motor blok başlangıç zamanı levobupivakain grubunda bupivakain grubuna göre daha uzun görüldü. Ancak levobupivakain grubunda motor blok gerileme zamanı istatistiksel olarak anlamlı kısa bulundu. Hemodinamik parametreler her iki grupta benzer bulundu Sonuç: Sonuçlarımız duyusal blok profili açısından bupivakaine benzer özellikler gösteren levobupivakainin özellikle motor blok gelişmesinin istenmediği operasyonlarda bupivakaine iyi bir alternatif olabileceğini göstermektedir.
  • Küçük Resim
    Öğe
    Aort patolojilerinin endovasküler tedavisinde anestezi yönetimi
    (Dicle Üniversitesi Tıp Fakültesi, 2014) Güzel, Abdulmenap; Doğan, Erdal; Karaman, Haktan; Aycan, İlker Öngüç; Çelik, Feyzi; Çiftçi, Taner; Demirtaş, Sinan
    Amaç: Bu çalışmamızda torakal ve abdominal aort patolojilerin endovasküler tedavisinde uyguladığımız anestezi yöntemlerini karşılaştırmayı ve literatür eşliğinde tartışmayı amaçladık. Yöntemler: Çalışmamız aort anevrizması ve aort disseksiyonu tanısı ile endovasküler tedavi uyguladığımız toplam 20 hastanın geriye dönük değerlendirilmesiyle gerçekleştirilmiştir. Hastaların demografik özellikleri, Amerikan Anestezi Derneği (ASA) skorları, laboratuar değerleri, eşlik eden hastalıklar, sigara kullanımı, ejeksiyon fraksiyonu, aort patolojisinin yeri ve tipi kaydedildi. Ayrıca uygulanan cerrahi işlem, anestezi yöntemleri, operasyon sırasında kullanılan kristalloid, kolloid ve kan ürünleri miktarları, anestezi ve cerrahi süresi, komplikasyonlar ve müdahaleler, yoğun bakım ünitesi ve hastanede kalış süreleri ile mortalite oranları kaydedildi. Tüm olgulara standart anestezi monitörizasyonu yapıldı. Bulgular: Toplam 20 (E=15, K=5) olgu çalışmamıza dahil edildi. Olgularımızın 16’sı ASA 3 ve 4’ü ASA 4 risk grubundaydı. Torakal endovasküler aort tamiri (TEVAR) uygulanan hastalarımızın tümüne genel anestezi verilirken abdominal endovasküler aort tamiri (EVAR) uygulanan hastalarımızdan 7 olguya rejyonel, 6 olguya genel anestezi ve bir olguya da sadece sedoaneljezi verilmiştir. EVAR uygulanan hastaların 8’inde HT varken TEVAR uygulanan hastalarımızın hepsinde HT mevcuttu. Gruplar arasında kan ve kan ürünleri transfüzyonu, preoperatif ve postoperatif hemoglobin, hematokrit, üre ve kreatin değerleri açısından istatiksel olarak anlamlı bir farklılık saptanmadı. Sonuçlar: EVAR ve TEVAR uygulamalarında genel anestezi, rejyonel anestezi, sedoanaljezi eşiliğinde lokal anestezi hastanın durumuna ve işlem yapılacak alana bağlı olarak başarılı bir şekilde uygulanabilmektedir.
  • Küçük Resim
    Öğe
    Apendektomi operasyonlarında iki farklı intratekal levobupivakain dozunun etkinliğinin karşılaştırılması
    (Modestum Publishing Ltd., 2012) Doğan, Erdal; Kavak, Gönül Ölmez; Çelik, Feyzi; Tüfek, Adnan; Yıldırım, Zeynep Baysal; Tokgöz, Orhan; Karaman, Haktan; Ay, Enver
    Amaç: Spinal anestezi, özellikle yandaş hastalıkların varlığında morbidite ve mortaliteyi azalttığı için birçok cerrahi uygulamada tercih edilmektedir. Bu çalışmada; spinal anestezi altında açık apendektomi operasyonu yapılacak hastalarda iki farklı doz levobupivakainin motor ve duyusal blok özellikleri, hemodinamik parametreler, cerrahi ve hasta konforu ve yan etkiler bakımından karşılaştırılması amaçlandı. Gereç ve yöntem: Bu çalışma Sağlık Bakanlığı Etik kurul izni ve hasta onamı alınarak prospektif olarak planlandı. Çalışmaya yaşları 18-40, ASA I-II grubu, spinal anestezi için kontrendikasyonu bulunmayan ve yapılacak girişimi kabul eden, perfore apandisit düşünülmeyen 50 olgu dâhil edildi. Grup I’e 3 ml (15 mg) %0.5 levobupivakain Grup II’ye 4 ml (20 mg) %0.5 levobupivakain intratekal verildi. Gruplar motor ve duyusal blok özellikleri, hemodinamik parametreler, cerrahi ve hasta konforu ve yan etkiler bakımından karşılaştırıldı. Bulgular: İki grup arasında iki segment regresyon zamanı Grup II’de Grup I’den daha uzun (Grup I: 120 ± 40 dk, Grup II: 158 ± 54 dk) bulundu (p<0.05). Ayrıca Grup II’de hipotansiyon ve bradikardi daha sık görüldü (p<0.05).. Grupların benzer hemodinamik etki, hasta ve cerrah memnuniyetine sahip olduğu gözlendi. Sonuç: Apendektomi operasyonlarında 3 ml (15 mg) %0.5 levobupivakain ile spinal anestezi uygulamalarının etkin, güvenli ve konforlu bir anestezi sağladığı sonucuna varıldı.
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    Öğe
    Assesment of Patients' Basic Knowledge and Concerns About Anesthesia: A survey study
    (Harran University, 2024) Dedeoğlu, Andaç; İpek, Yusuf; Kaçar, Cem Kıvılcım; Akelma, Hakan; Karaman, Haktan
    Background/Aim: This survey study aimed to investigate the knowledge and concerns of patients about anesthesia in the preoperative period. Materials and Methods: A total of 150 patients scheduled for elective surgery, aged 18 to 65, with ASA (American Society of Anesthesiologists) classification 1-2, were included in the study. Patients who come to the anesthesia outpatient clinic in the preoperative period were asked to complete survey forms. Results: It was observed that 47% of patients aged 60 and older had previous experiences with anesthesia (p=0.01). When the responses to the question "Do you know why you came to the anesthesia outpatient clinic?" were examined by age groups, it was found that 70% of patients aged 18-30, 70% of patients aged 31-60, and 29% of patients aged 60 and older did not know why they came to the anesthesia outpatient clinic (p=0.004). It was determined that as the level of education increased, the knowledge level about anesthesia increased and the level of concern decreased. Furthermore, it was found that as the socioeconomic status increased, the knowledge level about anesthesia increased. Conclusion: It was determined that the level of education and socioeconomic status were factors affecting the level of anesthesia knowledge. Furthermore, it was found that the level of concern related to anesthesia was also associated with the level of education.
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    Öğe
    Broken Racz catheter during application (Case report)
    (Kare Publ, 2006) Karaman, Haktan; Akay, Hatice Ozturkmen; Turhanoglu, Selim
    The most important complication of lumber disc hernia operations is Failed Back Surgery Syndrome (FBSS), which goes with fibrotic adhesions at the surgical site. The primary treatment applied to the cases that develop FBSS is the placement of Racz catheter under floroscopy and application of epidural neuroplasty which is a three-day procedure. However, this intervention, from which patients benefit a great deal, has some important complications during and after the application. One of these complications is that some pieces of Racz catheter may be broken out and retain at some levels of epidural space and subcutaneous tissue during placement and removal. General approach is to remove the retaining piece surgically. However, there is a less common view that, instead of removing the retaining piece, the patient should be followed up strictly and regularly in terms of neurologic complications. In our case, we decided to perform epidural neuroplasty to the patient diagnosed as FBSS. However, during the placement of the catheter, it was trapped in the left side of L-5-S-1 foramen by accident due to dense fibrotic tissues, and the subcutaneus part retained in the epidural space. Monthly follow-ups for 12 month were proposed to the patient, while surgery was not recommended. At the end of this period, no sign of infection was observed and neurologic and radiologic findings of the patient did not worsen. It is also interesting that a remarkable recovery was observed in the patient's clinical situation.
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    A Case of Pneumothorax after Phrenic Nerve Block with Guidance of a Nerve Stimulator
    (Korean Pain Soc, 2011) Beyaz, Serbulent Gokhan; Tufek, Adnan; Tokgoz, Orhan; Karaman, Haktan
    Hiccups have more than 100 etiologies. The most common etiology has gastrointestinal origins, related mainly to gastric distention and gastroesophageal reflux disease. Intractable hiccups are rare but may present as a severe symptom of various diseases. Hiccups are mostly treated with non-invasive or pharmacological therapies. If these therapies fail, invasive methods should be used. Here, we present a patient on whom we performed a blockage of the phrenic nerve with the guidance of a nerve stimulator. The patient also had pneumothorax as a complication. Three hours after intervention, a tube thoracostomy was performed. One week later, the patient was cured and discharged from the hospital. In conclusion, a stimulator provides the benefit of localizing the phrenic nerve, which leads to diaphragmatic contractions. Patients with thin necks have more risk of pneumothorax during phrenic nerve location.
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    Öğe
    Comparison of the effectiveness of intrathecal bupivacaine and Levobupivacaine in hip surgery
    (Slovene Medical Soc, 2013) Celik, Feyzi; Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Yildirim, Zeynep Baysal; Tokgoz, Orhan; Guzel, Abdulmenap
    Purpose: We aimed to compare the anesthetic and hemodynamic effects of intrathecally administered levobupivacaine and bupivacaine in combination with fentanyl in hip surgery. Subjects and methods: Sixty patients categorized as class 1 or 2 according to the American Society of Anesthesiologists (ASA) Physical Status classification, aged between 18 and 65 years and scheduled for hip surgery were randomly assigned to two groups. Patients in Group I received spinal anesthesia with 0.5 % bupivacaine 12.5 mg + fentanyl 10 mu g (total 2.6 ml), and patients in Group II received 0.5 % levobupivacaine 12.5 mg + fentanyl 10 mu g (total 2.6 ml) intrathecally. The level of sensory block and motor block was evaluated, and hemodynamic data were recorded. Results: The onset of sensory block and the time to two-segment regression were similar between the two groups. In the levobupivacaine group, the time to motor block onset was longer and the motor block regression time was shorter than that of bupivacaine group. The groups were similar with respect to hemodynamic data. Conclusion: We consider that levobupivacaine may be a good alternative to bupivacaine, particularly in surgical procedures where less motor block development is desired.
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    Complications and success rates of stellate ganglion blockade; blind technique vs. fluoroscopic guidance
    (Scientific Publishers India, 2017) Karaman, Haktan
    Objective: Stellate Ganglion Blockade (SGB) is a cervical sympathetic blockade technique that has been long applied for a variety of purposes in Anesthesiology and Pain Clinics. In this study, our goal is to reveal the kind of SGB complications, their frequency and success rates of SGBs based on the application methods (blind technique vs. fluoroscopy guidance). Material and methods: This retrospective study was conducted in the pain management center of a university hospital using patients' chart. Patients' charts compilation began in January 2004 and ended in June 2014. Then, the patient charts collected for the study were divided into two groups: the ones applied with blind techniques (Group-B) and the ones applied under fluoroscopy (Group-F). Thus, 223 patients in Group-B and 197 patients in Group-F, in total, data of 420 patients were collected. Results: Complications were seen in fourteen patients in Group-B, while twelve of them were blood aspirations due to the vertebral artery puncture. This puncture was observed in eight patients of Group-F. No statistically significant difference was observed between the groups when compared in terms of complications (P= 0.311). However, two patients in blind technique group were developed pneumothorax. Block failures of 6.28% in Group-B and 1.52% in Group-F were determined when compared in terms of failure rates. This difference between the two groups was statistically significant (P= 0.016). Conclusion: Complication rates are low and success rates are considerably high, if SGB is applied by experienced hands, even if with blind method.
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    The Complications of Transforaminal Lumbar Epidural Steroid Injections
    (Lippincott Williams & Wilkins, 2011) Karaman, Haktan; Kavak, Gonul Olmez; Tufek, Adnan; Yildirim, Zeynep Baysal
    Study Design. A prospective observational study. Objective. In this study, we aimed to investigate the major and minor complications of transforaminal lumbar epidural steroid injections guided by fluoroscopy and the incidence of vascular penetration encountered during this procedure. Summary of Background Data. Epidural steroid administration is one of the treatment options for lumbar disc hernia accompanied by radiculopathy. This method, initially applied by blind interlaminar technique, has generally been performed by fluoroscopically guided transforaminal method now. The complications of this method cause to a serious concern. The complications of this intervention have been reported by either mostly retrospective studies or case reports until now. Prospective studies with large patient series are needed to determine the types and incidences of the complications. Methods. In this study carried out for more than 5 years, major and minor complications of transforaminal lumbar epidural steroid injections were investigated prospectively. All of the interventions were performed under fluoroscopic guidance by the same physician using a standardized method. A follow-up was made once in the third week. The complications encountered during the procedure and in the third week were prospectively recorded. In addition, the incidence of vascular penetration that is potentially hazardous is included in the study. Results. A total of 562 patients were performed 1305 times transforaminal lumbar epidural steroid. The overall incidence of vascular penetration encountered was 7.4%. Although major complications were not seen, the total rate of all minor complications was 11.5%. Whereas all of the minor complications were transient, the most frequent minor complication was vasovagal reaction (8.7%). Conclusion. On the basis of the results of this study in which only minor complications were encountered, it can be said that the frequency of major complications is pretty rare in transforaminal lumbar epidural steroid injections in expert hands and in the conditions in which safety precautions are taken.
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    Cooled radiofrequency application for treatment of sacroiliac joint pain
    (Springer Wien, 2011) Karaman, Haktan; Kavak, Gonul Olmez; Tufek, Adnan; Celik, Feyzi; Yildirim, Zeynep Baysal; Akdemir, Mehmet Salim; Tokgoz, Orhan
    Background The unavailability of an effective and long-lasting treatment for sacroiliac-based pain has led researchers to study the efficacy of radiofrequency in denervation. In this study, we aimed to investigate the efficacy and safety of novel cooled radiofrequency application for sacral lateral-branch denervation. Methods Patients experiencing chronic sacroiliac pain were selected for our observational study. Fluoroscopy guidance cooled radiofrequency denervation was applied on the L5 dorsal ramus and the S1-3 lateral branches on patients who had twice undergone consecutive joint blockages to confirm the diagnosis and obtained at least 75% pain relief. At the 1st, 3rd and 6th month postoperatively, the patients' pain was evaluated using a visual analog scale (VAS), and their physical function was evaluated with the Oswestry Disability Index (ODI). Results Cooled radiofrequency was applied on a total of 15 patients. Prior to the procedures, the median VAS score (interquartile range) was 8 (7-9), but at the 1st, 3rd and 6th month, this had fallen to 3 (1-4), 2 (1-3) and 3 (2-4). The baseline median ODI score (interquartile range) was 36 (32-38), while at the 1st, 3rd and 6th month, it was 16 (820), 12 (9-18) and 14 (10-20), respectively. At the final control, while 80% of the patients reported at least a 50% decline in pain scores, 86.7% of those reported at least a ten-point reduction in ODI scores. Conclusion It was seen that the cooled radiofrequency used for sacroiliac denervation was an effective and safe method in the short to intermediate term.
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    Demographical Features of Patients with Suicidal Drug Intoxication, Glasgow Coma Scale and Revised Trauma Score Relationship with Mortality
    (Aves, 2012) Ozhasenekler, Rojsin A.; Karaman, Haktan; Kavak, Gonul O.; Tufek, Adnan; Yildirim, Zeynep; celik, Feyzi; Tokgoz, Orhan
    Objective: It is aimed in this study to analyze whether a relationship exists between mortality and demographical features, Glasgow coma scale (GCS) plus revised trauma scores (RTS) of inpatients diagnosed with suicidal drug intoxication. Material and Methods: Files of a total of 120 patients admitted in the reanimation unit because of suicidal drug intoxication whose data we could access were analyzed retrospectively. Results: 75.8% (n=91) of our patients were female while female/male ratio was 3.13/1. The average age of our patients was 25.18 +/- 10.26 years whereas mean arterial blood pressure, mean pulse rate and mean respiratory rate were 85.09 +/- 18.08 mmHg, 105.25 +/- 27.07 and 11.54 +/- 4.39, respectively. Mean GCS and RTS values of our patients on initial admission were 10.48 +/- 3.34 and 6.52 +/- 1.20, respectively. Mean duration of hospital stay of our patients was 6.43 +/- 14.2 days. 64 of our patients (53.3%) ingested a tricyclic antidepressant, while 22 (18.3%) took organic phosphorus. 33 (27.5%) cases were multipledrug intoxication. 37 patients (30.8%) required mechanical ventilation support and mean duration of follow-up under mechanical ventilation support was found to be 2.39 +/- 9.08 days. 11 of our patients (9.1%) died. A statistically significant relationship was found not only between mortality and organic chlorine (p=0.002) plus TCA intoxication (p=0.003), but also between mortality and GCS (p<0.001) plus RTS (p=0.003). Conclusion: Since suicidal drug intoxications are among important issues faced in the emergency room and intensive care units, it was concluded that physiological scoring systems used for initial assessment and follow-up, as well as the kind of drug taken had impacts on mortality.
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    Effectiveness of nucleoplasty applied for chronic radicular pain
    (Int Scientific Information, Inc, 2011) Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Yildirim, Zeynep Baysal; Temel, Vildan; Celik, Feyzi; Akdemir, Mehmet Salim
    Background: Over the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than I year. Material/Methods: Patients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index. Results: Mean VAS that was 8.7 +/- 1.1 before the procedure was determined to be 3.4 +/- 1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1 +/- 10.2 in the beginning, they went down to 33.9 +/- 14.9 at the end of 2 years. The percent of those stating good and excellent satisfaction was 66% (23 persons) on the last follow-up. Conclusions: While it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.
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    Efficacy of transforaminal lumbar epidural steroid injections in patients with lumbar radiculopathy
    (Kare Publ, 2012) Cetin, Mehmet Fatih; Karaman, Haktan; Kavak, Gonul Olmez; Tufek, Adnan; Yildirim, Zeynep Baysal
    Objectives: This study looks into the efficacy and safety of the transforaminal lumbar epidural steroid injection (TLESI) applied to patients with radiculopathy due to lumbar disk herniation. Methods: The patients' files which were applied TLESI, were retrospectively scanned. Patients who did not respond to one-month conservative treatment and who were detected to have bulging or protruding lumbar disk herniation as a result of imaging methods were included in the study. All applications were performed with C-arm fluoroscopy under local anesthesia by outpatient method. In all cases, a mix of 80 mg triamsinolone and 0.25% bupivacaine, was transforaminally injected to the anterior epidural area. Initial VAS pain scores were compared with the values of the 1, 3 and 6th months after the application. Patient satisfaction was determined through scoring. Furthermore, early and late term complications were collected for evaluation. Results: A total of 222 patients were administered TLESI 460 times (average: 2.1, repeat interval: 1-6 times). The applications were carried out most frequently at the levels of L4-L5 and L5-S1. While the initial VAS score average was 8.2 +/- 0.7, after TLESI, it was 5.0 +/- 1.6, 4.8 +/- 1.5 and 5.1 +/- 1.5 in the 1, 3 and 6th months, respectively. 63.9% of the patients (n=142) defined the treatment as 'good and excellent'. No major complications were experienced and the overall minor complication rate was 11.1%. Conclusion: It was seen that TLESI was an efficient and safe method in the short and medium term.
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    Endotrakeal ekstübasyona bağlı gelişen hemodinamik yanıtın kontrolünde deksmedetomidin, esmolol ve lidokainin etkinliğinin karşılaştırılması
    (2011) Tüfek, Adnan; Tokgöz, Orhan; Yıldırım, Zeynep Baysal; Çelik, Feyzi; Karaman, Haktan; Kavak, Gönül Ölmez; Akarca, Doğan
    Amaç: Çalışmamızda endotrakeal ekstübasyona bağlı gelişen hemodinamik yanıtın kontrolünde deksmedetomidin, esmolol ve lidokainin etkinliğinin karşılaştırılması amaçlandı. Gereç ve Yöntem: Bu prospektif çalışmada ASA I-II grubu, 18–60 yaş arası 80 hasta Grup I (Deksmedetomidin), Grup II (Lidokain), Grup III (Esmolol) ve Grup IV (Kontrol) olmak üzere rastgele yirmişer kişilik 4 gruba ayrıldı. Cerrahi sonunda 5 dk içerisinde; Grup I’ deki hastalara 1 ?g/kg deksmedetomidin, Grup II’ deki hastalara 2 mg/kg lidokain, Grup III’ deki hastalara 1.5 mg/kg esmolol ve Grup IV’ teki hastalara %0.9 NaCl verildi. Gruplar arasında ekstübasyon sırasındaki ve sonrasındaki hemodinamik veriler ile ekstübasyon kalitesi karşılaştırıldı. Bulgular: Kalp tepe atımı (KTA) değerleri gruplar arası ve grup içinde karşılaştırıldığında; deksmedetomidin grubunda tüm ölçüm zamanlarında istatistiksel olarak anlamlı düşük bulundu. Ortalama arter basınçlarının (OAB) gruplar arası karşılaştırılmasında; OAB değerleri deksmedetomidin grubunda diğer 3 gruba göre istatistiksel olarak anlamlı düşük bulundu. OAB’ larının grup içi karşılaştırmasında ise deksmedetomidin grubunda tüm ölçüm zamanlarındaki OAB değerleri arasında istatistiksel olarak anlamlı bir farklılık bulunmazken, diğer tüm gruplarda OAB değerlerinde artış gözlendi. Sonuç: Ekstübasyona bağlı hemodinamik yanıtın kontrolünde deksmedetomidinin, lidokain ve esmolola göre daha üstün olduğu, lidokainin ekstübasyona bağlı gelişen hemodinamik yanıtın önlenmesinde yetersiz kaldığı, esmololün ise KTA artışını önlemede etkili olurken OAB üzerinde deksmedetomidin kadar etkili olmadığı sonucuna varıldı.
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    Evaluation of the effects of anesthetic agents and diagnoses on seizure durations, recovery times and complications in electroconvulsive therapy
    (Turkish Association for Psychopharmacology, 2014) Tüfek, Adnan; Bulut, Mahmut; Tokgöz, Orhan; Çelik, Feyzi; Yıldırım, Zeynep Baysal; Atli, Abdullah; Kaya, Mehmet Cemal; Karaman, Haktan
    Objective: The aim of this study is to retrospectively evaluate the influence of diagnosis and three different anesthetic agents on seizure durations, hemodynamic parameters, recovery times, and side effects in electroconvulsive therapy (ECT). Method: We have retrospectively evaluated 1342 ECT sessions conducted on 179 patients under general anesthesia at the Psychiatry Department of Dicle University Hospital between 1 September 2009 and 30 June 2012. The relationship between the indications for ECT and the choice of anesthetic agent, number of ECT sessions, motor and EEG seizure durations, recovery times from anesthesia, hemodynamic changes and complications were analysed. Results: The mean age of the 179 patients included in the study was 36.7±7.3 years. In terms of sex, 50.8% (n=91) were male and 49.2% (n=88) were female. The most commonly used anesthetic agent was propofol (73.2%). Among the patients, 50.8% was diagnosed with major depression, 28.5% had bipolar disorder and 12.8% was diagnosed with schizophrenia. A total of 179 (13.3%) out of the 1342 ECT sessions were considered as failed. In 92.2% of the failed ECTs, the anesthetic agent was propofol. No statistically significant relationship was observed between the diagnosis forming the basis for the ECT and the motor and EEG seizure times, beginning of spontaneous breathing, eye opening, time until response to verbal stimuli, changes in hemodynamic parameters and complications. The seizure and recovery times were significantly shorter in the propofol group compared to the ketamine and etomidate groups (p<0.05). The EEG seizure durations were longer in the etomidate group in comparison to the propofol and ketamine groups (p<0.001 and p<0.05, respectively). Conclusion: The diagnoses leading to the ECT have no influence on the motor and EEG seizure times, beginning of spontaneous breathing, eye opening, times of response to verbal stimuli, hemodynamic parameters or complications. However, the anesthetic agents used influence all of these parameters.
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    İleri derece yaşlı hastada mini doz bupivakain ile spinal anestezi
    (Modestum Publishing Ltd., 2010) Çelik, Feyzi; Tüfek, Adnan; Yıldırım, Zeynep Baysal; Karaman, Haktan; Baykan, Halit; Kavak, Gönül Ölmez; Temel, Vildan
    Kalça ve alt ekstremite cerrahisi uygulanan hastaların büyük bir çoğunluğu ileri yaş grubundadır. Bu yaş grubundaki hastalarda kardiyak, endokrin, renal, serebral ve respiratuvar hastalıkların varlığı, peroperatif ve postoperatif morbidite ve mortalite riskini artırmaktadır. Bu olguda sağ kalça protezi operasyonu yapılan 106 yaşındaki erkek hastanın anestezi yönetimi sunulmuştur. Klin Den Ar Derg 2010; 1(3): 214-215.