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    Cerrahi girişimler ve immünsüpresyon
    (Maltepe Üniversitesi, 2014) Özer, Zeliha; Selvi, Onur
    Cerrahi girişimler postoperatif dönemde immünsüpresyona neden olan bir çok metabolik ve endokrin yanıt oluşturmaktadır. Bu genel immünsüpresyon durumu septik komplikasyonlar ve tümör metastaz oluşumuna yol açabilmektedir. Altta yatan mekanizmaların anlaşılması, bu etkiyi azaltmak için gerekli stratejilerin oluşturulmasını sağlayacaktır.
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    Comparison of ultrasound-guided lumbar erector spinae plane block and transmuscular quadratus lumborum block for postoperative analgesia in hip and proximal femur surgery: A prospective randomized feasibility study
    (National Center for Biotechnology Information Search database, 2018) Tulgar, Serkan; Köse, Halil Cihan; Selvi, Onur; Şentürk, Özgür; Thomas, David Terence; Ermiş, Mehmet Nurullah; Özer, Zeliha
    Study Objective: Lumbar Erector spinae Plane block (L?ESPB) is a modification of a recently described block. Both L?ESPB and Transmuscular Quadratus Lumborum block (QLB?T) have been reported to provide effective postoperative analgesia in hip and proximal femur surgery. Herein, we compare the effectiveness of L?ESPB and QLB?T in providing postoperative analgesia in patients undergoing hip and femur operations. Design: Double?blinded, prospective, randomized, feasibility study. Setting: Tertiary university hospital, postoperative recovery room and ward. Methodology: A total of 72 patients (American Society of Anesthesiology physical status classification II?III) were recruited. After exclusion, 60 patients were allocated to three equal groups (control, L?ESB and QLB?t). Interventions: Standard multimodal analgesia was performed in the control group while L?ESPB or QLB?T was performed in the block groups. Measurements: Pain intensity between groups was compared using Numeric Rating Scores. Furthermore, tramadol consumption and additional rescue analgesic requirement was measured. Results: There was no difference between demographic data or type of surgery. While there was no difference in Numeric Rating Scale (NRS) score at any hour between the block groups; NRS scores at the 1st, 3rd and 6th h, tramadol consumption during the first 12 h and total tramadol consumption, the number of patient required rescue analgesic in 24 h were significantly higher in the control group compared to both block groups. Conclusion: While L?ESPB and QLB?T have similar effect, they improve analgesia quality in patients undergoing hip and proximal femoral surgery when compared to standard intravenous analgesia regimen.
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    Erector spinae block in 308 patients: Complications and unexpected events
    (Regional Anesthesia & Pain Medicine, 2019) Tulgar, Serkan; Selvi, Onur; Thomas, David Terence; Özer, Zeliha
    Background and aims: Erector spinae plane block (ESPB), which has been the subject of over 200 papers in a very short time, is a recent and popular block with a few reported complications. Herein, we report our clinical experience of ESPB’s complications and related unexpected events. Methods: We retrospectively evaluated block follow-up forms of 308 patients who received ESPB for postoperative analgesia or chronic pain management. the indication of block, application level of the block, details of local anesthetic drugs together with complications and unexpected events, such as artery puncture hematoma, infection, at the moment of block application and in following 24 hours were recorded in the forms. Results: A total number of interventions were 479. of these, 137 were unilateral, 132 were bilateral, 22 were unilateral-bilevel and 17 were bilevel-bilateral. Pneumothorax, hemidiaphragmatic paralysis or similar respiratory complications were not observed. Only one patient experienced motor weakness. a total of 4 patients had suspicious minor neurological findings related to local anesthesia toxicity. No major neurological or minor/major cardiological findings were observed. No complications such as nerve damage or organ damage were observed. Bilateral sensory block was detected in 1 patient who underwent unilateral thoracic ESPB. a complete epidural block below the T12 level was determined in a patient with a history of spinal surgery after unilateral lumbar ESPB. Conclusions: This single center experience showed that ESPB is a regional anesthesia technique with a low complication rate.
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    Evaluation of ultrasound-guided transversalis fascia plane block for postoperative analgesia in caesarean section: a prospective, randomized, controlled clinical trial
    (Regional Anesthesia & Pain Medicine, 2019) Şerifsoy, Talat Ercan; Tulgar, Serkan; Selvi, Onur; Şentürk, Özgür; İlter, Erdin; Haliloğlu Peker, Berna; Özer, Zeliha
    Background and aims: Caesarean section (C/S) is a commonly performed obstetric procedure causing a somatic pain and a visceral pain. Pain treatment leads to decreased maternal morbidity, early mobilization and increases patient satisfaction. Adding a regional anesthesia technique to multimodal analgesia in C/S, improves the quality of postoperative care. In this study, we evaluated the effectiveness of transversalis fascia plane block (TFPB) first time for postoperative analgesia management in C/S. Although it is an old and practical block currently it was only investigated in a few studies. Methods: The study was approved by the local ethics committee and the study was registered with clinicaltrials.gov (NCT03741452). Following exclusion, patients were randomized equally as block and control group. Standard multimodal analgesia was performed in Group C while TFPB block was also performed in the intervention (TFPB) group. Our primary outcome was to evaluate Tramadol consumption and additional rescue analgesic requirement. Our secondary outcome was to assess pain intensity between groups with numeric rating scores. Results: Seventy-five patients (ASA I-II) were recruited. NRS scores were lower in Group TFPB during the first 3 hours and at the 12th hour. Tramadol consumption at 3rd, 6th and 12th hours and in the first 24 hours was lower in Group TFPB (p<0.01) (figure 1). NRS scores were lower in the block group at 1st, 3rd and 12th hours (p<0.01, p<0.01 and p<0.01 respectively).
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    FLUMAZENİL BENZODİAZEPİNLER DIŞINDAKİ ANESTEZİK AJANLARI DA ETKİLER Mİ?: OLGU SUNUMU
    (2015) Özer, Zeliha; Şentürk, Özgür; Selvi, Onur
    Flumazenil benzodiazepinlerin sedatif ve hipnotik etkilerini geri çevirmek için kullanılan bir imidazobenzodiazepindir.Yakın tarihlerde yayınlanan çalışmalarda, mekanizması tam açıklanamasa da, Flumazenilin di¤er genel anestezik ajanlar üzerine de etkili olabilece¤ine dikkat çekilmektedir. Bu nedenle, bu olgu sunumunda uyanmaları beklemedi¤imiz şekilde geciken iki hastada Flumazenil ile olan deneyimimizin paylaşılması amaçlanmıştır. Preoperatif muayenelerinde ASA I olarak de¤erlendirilen, 18 ve 19 yaşlarında iki erkek hasta sırasıyla, tonsillektomi, adenoidektomi ve septorinoplasti yapılmak üzere operasyona alındı. Hastalardan birine ameliyathaneye gelmeden 30 dk. önce yapılan Midazolam (1mg iv) dışında, anestezi indüksiyon (Propof ol, Fentanil) ve idamesinde (Sevof luran, Remif entanil) aynı ajanlar kullanıldı. Operasyonların sonunda anestezik ajanlar kesilip, kas gevşetici etkisini geri çevirmek için Atropin ve Neostigmin yapıldı; ancak 30-45 dk beklenmesine karşın uyanıklık belirtisi ve solunum ef oru saptanmadı. Bu klinik tabloyu açıklayacak bir neden bulunamaması üzerine Flumazenil (0,5mg iv) uygulandı. Her iki hasta da birkaç dakika içinde gözlerini açtı ve solumaya başladı. Bu iki olgudaki deneyimimiz, gecikmiş derlenmelerde Flumazenil kullanımının göz ardı edilmemesi gerekti¤ini ve etki mekanizmasının anlaşılması adına, detaylı araştırma yapılmasının yararlı olaca¤ını göstermektedir.
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    Koroner Arter Bypass Greft Hastalarında Pulmoner Fonksiyonlar ve Nötrofil Lenfosit Oranı Arasında Korelasyon Var mı?
    (2017) Bayserke, Olgar; Tulgar, Serkan; Özer, Zeliha; Selvi, Onur
    GİRİŞ ve AMAÇ: Pulmoner Fonksiyon Testleri (PFT) kardiyotorasik cerrahi öncesi preoperatif değerlendirmede sık başvurulan önemli bir testtir. Nötrofil lenfosit oranı ise birçok çalışmaya konu olmuş, bir çok hastalık ile ilişkisi olduğu ortaya konmuş bir biyomarkerdır. Benzer şekilde platellet lenfosit oranı (PLR) ve sistemik immun inflamatuar indexte çalışmalara konu olmaktadır. Bu çalışmada amacımız; CABG hastalarında yapılan PFT ile bu oranlar arasında bir ilişki olup olmadığını araştırmaktır. YÖNTEM ve GEREÇLER: Bu retrospektif çalışmada Ocak 2014 ile Austos 2015 tarihleri arasında merkezimizde CABG uygulanan hastaların verilerini değerlendirilmiştir. CABG uygulanan hastaların demografik özellikler, kan sayımları, NLR, PLR, SIII ve PFT sonuçları kayıt altına alınarak değerlendirilmiştir. BULGULAR: CABG uygulanan 61 hastanın verileri değerlendirildi. NLRile FEV1/FVC ve NLR ile MMEF75-25 arasında negatif yöne bir korelasyon tespit edildi (p<0.01).NLR için MMEF 75-25 < %80 ve FEV1/FVC<%80 olduğunda cut-off değeri belirlemek için ROC analizi yapıldı ve cut off değeri 2.105 olarak belirlendi (Sensitivity %67 ve specificity % 73) TARTIŞMA ve SONUÇ: Respiratuar hastalık öyküsü olmayan ve CABG uygulanacak hastalarda NLR pılmoner fonksiyon testleri ine ters yönlü bir korelasyon göstermektedir. Çalışmamız, tam kan sayımından türetilen basit bir biyomarker olan NLR ile pulmoner fonksiyon testleri ilişkisini ortaya koyan ilk çalışmadır.
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    LAPAROSKOPİK KOLESİSTEKTOMİ OLGULARINDA PROSEAL LARİNGEAL MASKE VE ENDOTRAKEAL TÜPÜN KAF BASINCI VE HAVAYOLU ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI
    (2018) Türkmenolu, Özgür; Birbiçer, Handan; Taşdelen, Bahar; Bülbül, Selma; Özer, Zeliha; Doruk, Nurcan
    Amaç: Laparoskopik kolesistektomi planlanan hastalarda endotrakeal entübasyon (ETT) ve proseal laringeal maske (PLMA) uygulamasınınkaf basıncı ve havayolu üzerine etkilerinin karşılaştırılması amaçlandı. Yöntem: Çalışma genel anestezi altında laparoskopik kolesistektomi planlanan, ASA I-II, 20-70 yaş arasında toplam 41 hasta üzerinde yapıldı.Grup ETT'de (n=19) hastalara ETT, Grup PLMA'da (n=22) ise PLMA yerleştirildi. Her iki gruba da nazogastrik tüp yerleştirilerek mide içeriğiaspire edildi. Olguların demografik verileri, havayolu araçlarının yerleştirme süreleri ve girişim sayıları kaydedildi. Preoperatif, peroperatif 5., 10.,15., 30., 45., 60., 75. dakikalarda hemodinamik ve solunumsal parametreler, kaf basınçları kaydedildi. Karboperitonyum öncesi, sonrası pik havayolubasınçları ve postoperatif dönemdeki komplikasyonlar (kanama, boğaz ağrısı, yutma güçlüğü, laringospazm, bronkospazm) kaydedildi.Bulgular: Demografik veriler, güvenli havayolu sağlamak için uygulanan girişim sayıları, kaf basınçları, hemodinamik ve solunumsalparametreler her iki grupta da benzerdi. Postoperatif komplikasyonlardan boğaz ağrısı ve yutma güçlüğü görülme sıklığı ETT uygulanan gruptaistatistiksel olarak anlamlı derecede yüksekti (p<0.001). Laringospazm ve bronkospazm açısından gruplar arasında farklılık bulunmadı. Pik havayolubasıncı bakımından karboperitonyum öncesi ve sonrası arasındaki farklılık her iki grupta da anlamlı bulundu (p<0.001). Ancak gruplar arasındaistatistiksel olarak anlamlı fark saptanmadı.Sonuç: Sonuç olarak nazogastrik tüp girişine olanak sağlayan PLMA'nın gastrik distansiyonu önlemesi, boğaz ağrısı ve yutma güçlüğüneneden olmamasından dolayı laparoskopik girişimlerde ETT'e alternatif bir havayolu aracı olabileceği kanaatindeyiz
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    Lumbar erector spinae plane block as a main anesthetic method for hip surgery in high risk elderly patients: A magnetic resonance imaging and observational study
    (Regional Anesthesia & Pain Medicine, 2019) Ahıskaoğlu, Ali; Tulgar, Serkan; Çelik, Mine; Özer, Zeliha; Alıcı, Hacı Ahmet
    Background and aims: In this study we aimed to showed our successful experience with lumbar erector spinae plane (ESP) block as a main anesthetic technique in fifteen high risk elderly patients undergoing hip surgery with mild propofol sedation. Also we demonstrate magnetic resonance images and discuss the anatomic basis of lumbar ESP block. Methods: This study was conducted at Istanbul Maltepe University and Erzurum Ataturk University Faculties of Medicine. This study includes patients that fit the aforementioned description and gave written informed consent for L-ESPB with mild sedoanalgesia to be used as the primary anesthesia technique and underwent hip surgery. Results: All patients’ surgeries were completed without requirement for general anesthesia or local anesthesia infiltration of the surgical site. Surgical time, perioperative propofol and intraoperative ketamine requirement are shown in table 1. All patients’ NRS score were <2/10 in the recovery room. Significant contrast spread was observed between the Th12 and L5 transverse process and erector spinae muscle and between multifidus muscle and iliocostal muscle at the L2-4 levels. Contrast material was observed at the anterior of the transverse process spreading to the paravertebral, foraminal and partially epidural area/spaces and also in the areas where the lumbar nerves enter the psoas muscle (figure 1).
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    The Maltepe combination: Novel parasacral interfascial plane block and lumbar erector spinae plane block for surgical anesthesia intransfemoral knee amputation
    (Elsevier, 2019) Tulgar, Serkan; Selvi, Onur; Şentürk, Özgür; Özer, Zeliha; Ünal, Ömer Kays; Thomas, David Terence
    The Maltepe combination: Novel parasacral interfascial plane block and lumbar erector spinae plane block for surgical anesthesia intransfemoral knee amputation. For patients undergoing transfemoral (above knee) amputation, anesthesia options are generally limited due to concomitant complex medical problems of the patients. In patients undergoing transfemoral amputation, regional anesthesia techniques may be life-saving when it is necessary to avoid general or neuraxial anesthesia. The blockage of lumbar and sacral plexus or their components are generally applied for thispurpose.
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    New indication for novel block: Sacral erector spinae plane block for inferior cluneal/sacral nerve entrapment syndrome
    (Regional Anesthesia & Pain Medicine, 2019) Tulgar, Serkan; Selvi, Onur; Thomas, David Terence; Özer, Zeliha
    Background and aims: Inferior cluneal nerve entrapment syndrome (ICNES) is a rare and painful condition. Piriformis injections, piriformis release and caudal injections are used in the treatment. Herein, we report our successful application of sacral erector spinae plane block (ESPB) in a patient suffering from persistent ICNES. Methods: A 72-year-old female patient, who had been taking oral tramadol, gabapentin and paracetamol due to the pain in her left inferomedial gluteal region for 4 years, was scheduled for sacral ESPB. Formerly, the patient received piriformis injection twice, caudal injection twice in addition to a pudendal nerve block, and a pudendal nerve release surgery. High frequency linear transducer was placed on the fifth spinous process on the transverse plane when the patient was in the prone position. The transducer was then placed 3-4 cm lateral to the second medial sacral crest to visualise the intermediate sacral crest. In the interfascial plane, 20 mL of local anesthetic (10 mL bupivacaine 0.5%, 5 mL lidocaine 2%, 40 mg/2 mL metilprednizolon ve 3 mL normal saline) was injected between the erector spinae muscles and intermediate sacral crest. Results: The patient expressed relief of her pain after 5 minutes following sacral ESPB application. At the third week of post-intervention period, she no longer required oral medication. The intervention was repeated after 6 weeks due to mild pain. Conclusions: Sacral ESPB may be a good option in cases with entrapment syndrome of posterior sacral nerve branches.
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    A novel approach to blockage of pectoral nerves: Ultrasound guided Modified Clavipectoral Fascial Plane Block (PECs-Zero)
    (Elsevier Inc., 2020) Tulgar, Serkan; Selvi, Onur; Thomas, David Terence; Deveci, Uğur; Özer, Zeliha; Deveci, Uğur
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    Peripheral Block Education and Level of Competency: A Survey of Turkish Anesthesiologists
    (Aves, 2020) Selvi, Onur; Tulgar, Serkan; Şentürk, Özgur; Tas, Zafer; Kose, Halil Cihan; Topcu, Deniz İlhan; Özer, Zeliha
    BACKGROUND/AIMS Presently, in Turkey, there is no work being conducted on the period of regional anesthesia education, and there are no statistics available on the frequency with the administration of basic extremity blocks. The present survey was conducted on anesthesia doctors throughout Turkey to explore the personal knowledge and competency of the participants. Simultaneously, this survey aimed to evaluate the information sources for regional anesthesia training in Turkey. MATERIAL and METHODS The present study surveyed 377 anesthesia doctors in March 2017 through a questionnaire formulated on the Delphi platform. The voluntary participants were recruited from professional organizations, hospital portals, and Turkey's anesthesia departments. Descriptive analyses were conducted for statistical evaluation. RESULTS Of the total participants, 3.2% were professors, 3.2% were associate professor doctors, 7.4% were assistant professors, 64.5% were specialist doctors, and 21.8% were residents. In the segment concerning skill and information level self-evaluation for blocks, the most commonly performed act was infraclavicular block (26.8%). With regard to their information source, 40% of the participants chose from my colleagues for upper extremity blocks. The specialist training was the least popular information source for ultrasound-guided interscalene block, while the digital visual information sources were often consulted for the same. CONCLUSION Various sources have been identified as the source of information as much as the specialty training, more so in some blocks. A significant majority of the participants avoided block applications. In the future, it would be useful to collect data on a more comprehensive national scale to overcome the limitations of the present issue.
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    Translation and Validation of the Turkish Version of the Quality of Postoperative Recovery Score QoR-15: A Multi-Centred Cohort Study
    (Aves, 2022) Selvi, Onur; Azizoğlu, Mustafa; Temel, Gülhan; Tulgar, Serkan; Chitneni, Ahish; Çınar, Ece Nur; Özer, Zeliha
    Objective: The Quality of Recovery-15 questionnaire is a self-rated questionnaire used to assess the quality of the postoperative recovery and health status of patients in the early period following surgery. The aim of this study was to assess the reliability, validity, and responsiveness of the Turkish version of the Quality of Recovery-15. Methods: After approval by the Maltepe University local ethics committee, this observational study was conducted among patients who received surgical interventions at Mersin University Hospital between July 2019 and January 2020. Reliability, feasibility, and validity were assessed to validate the Turkish version of the Quality of Recovery-15. Results: The completion rate of the form was determined to be 92% and a total of 200 patients were enrolled in the study. The Cronbach's alpha of the global Turkish version of the Quality of Recovery-15 was 0.927. Test-retest reliability was 0.84 [CI 95%: 0.75-0.90] and Cohen's effect size was 0.319. The total standardized response mean was determined as 0.53. Conclusions: This is the first study in which the Quality of Recovery-15 scale was translated into Turkish with our knowledge. The Turkish version of the Quality of Recovery-15 showed satisfactory reliability and validity in evaluating the quality of recovery after surgery in the Turkish population.
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    Use of the ultrasound guided erector spinae block as an alternative anesthesia method in a selected video assisted thoracoscopy case
    (Regional Anesthesia & Pain Medicine, 2019) Tulgar, Serkan; Selvi, Onur; Kızıltunç, B.; Orki, Alpay; Koşar, Altuğ; Özer, Zeliha
    Background and aims: Video assisted thoracoscopy (VATS) is a frequently used method for both therapeutic and diagnostic purposes. VATS is usually performed under general anesthesia; however, paravertebral block or other regional techniques could be used as an option in selected patients undergoing thoracoscopic diagnostic biopsy. In this case presentation, we present the application of ultrasound guided erector spinae block (ESPB) for the management of a VATS case as a main anesthesia method. Methods: A 58 years old male patient who had a chest drain due to chronic right lung empyema after chemotherapy treatment due to lung cancer, was planned for diagnostic VATS. ESPB at level of T5 was applied with out-plane technique in lateral position under sedoanalgesia with midazolam 2 mg and fentanyl 25 mcg. Mixture of local anesthetics composed of 20 mL bupivacaine 0.5% and 10 mL lidocaine 2% was applied between transverse process and erector spinae muscle. Results: The sensorial block between T2-T7 dermatomes was confirmed with pinprick test after 30 minutes following block application. Deep dermal and subcutaneous surgical tissue biopsies were sampled in 4 abdominal quadrant. The video camera equipment was advanced into thorax cavity. Small lobular pathologies between lung parenchyma and thoracic wall were observed and dissected. The surgery lasted for 25 minutes. Whenever the patient revealed discomfort and mild pain additional 10 mg intravenous ketamine was applied and repeated three times.