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Yayın The antimicrobial activity of ephedrine and admixture of ephedrine and propofol: an in vitro study(ELSEVIER SCIENCE INC, 2018) Tulgar, Serkan; Alasehir, Elcin Akduman; Selvi, OnurIntroduction: Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital-acquired infection pathogens of ephedrine alone or combined with propofol. Material and method: The study was performed in two stages. In the first, the Minimum Inhibitory Concentration of propofol and ephedrine alone and combined was calculated for Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa, and a clinical isolate of Acinetobacter spp. at 0, 6, 12 and 24 h, using the microdilution method. In the second stage, the same drugs and combination were used to determine their effect on bacterial growth. Bacterial solutions were prepared at 0.5 MacFarland in sterile 0.9% physiological saline and diluted at 1/100 concentration. Colony numbers were measured as colony forming units. mL(-1) at 0, 2, 4, 6, 8, 10 and 12th hours. Results: Ephedrine either alone or combined with propofol did not have an antimicrobial effect on Escherichia coli, Enterococcus faecium, or Pseudomonas aeruginosa and this was similar to propofol. However, ephedrine alone and combined with propofol was found to have an antimicrobial effect on Staphylococcus aureus and Acinetobacter species at 512 mcg. mL(-1) concentration and significantly decreased bacterial growth rate. Conclusion: Ephedrine has an antimicrobial activity on Staphylococcus aureus and Acinetobacter species which were frequently encountered pathogens as a cause of nosocomial infections. (C) 2017 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.Yayın Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications(ELSEVIER SCI LTD, 2019) Cortegiani, A.; Gregoretti, C.; Neto, A. S.; Hemmes, S. N. T.; Ball, L.; Canet, J.; Hiesmayr, M.; Hollmann, M. W.; Mills, G. H.; Melo, M. F. V.; Putensen, C.; Schmid, W.; Severgnini, P.; Wrigge, H.; de Abreu, M. Gama; Schultz, M. J.; Pelosi, P.; Kroell, Wolfgang; Metzler, Helfried; Struber, Gerd; Wegscheider, Thomas; Gombotz, Hans; Hiesmayr, Michael; Schmid, Werner; Urbanek, Bernhard; Kahn, David; Momeni, Mona; Pospiech, Audrey; Lois, Fernande; Forget, Patrice; Grosu, Irina; Poelaert, Jan; van Mossevelde, Veerle; van Malderen, Marie-Claire; Dylst, Dimitri; van Melkebeek, Jeroen; Beran, Maud; de Hert, Stefan; De Baerdemaeker, Luc; Heyse, Bjorn; Van Limmen, Jurgen; Wyffels, Piet; Jacobs, Tom; Roels, Nathalie; De Bruyne, Ann; van de Velde, Stijn; Leva, Brigitte; Damster, Sandrine; Plichon, Benoit; Juros-Zovko, Marina; Djonovic-Omanovic, Dejana; Pernar, Selma; Zunic, Josip; Miskovic, Petar; Zilic, Antonio; Kvolik, Slavica; Ivic, Dubravka; Azenic-Venzera, Darija; Skiljic, Sonja; Vinkovic, Hrvoje; Oputric, Ivana; Juricic, Kazimir; Frkovic, Vedran; Kopic, Jasminka; Mirkovic, Ivan; Karanovic, Nenad; Carev, Mladen; Dropulic, Natasa; Saric, Jadranka Pavicic; Erceg, Gorjana; Dvorscak, Matea Bogdanovic; Mazul-Sunko, Branka; Pavicic, Anna Marija; Goranovic, Tanja; Maldini, Branka; Radocaj, Tomislav; Gavranovic, Zeljka; Mladic-Batinica, Inga; Sehovic, Mirna; Stourac, Petr; Harazim, Hana; Smekalova, Olga; Kosinova, Martina; Kolacek, Tomas; Hudacek, Kamil; Drab, Michal; Brujevic, Jan; Vitkova, Katerina; Jirmanova, Katerina; Volfova, Ivana; Dzurnakova, Paula; Liskova, Katarina; Dudas, Radovan; Filipsky, Radek; el Kafrawy, Samir; Abdelwahab, Hisham Hosny; Metwally, Tarek; Abdel-Razek, Ahmed; El-Shaarawy, Ahmed Mostafa; Hasan, Wael Fathy; Ahmed, Ahmed Gouda; Yassin, Hany; Magdy, Mohamed; Abdelhady, Mahdy; Mahran, Mohamed; Herodes, Eiko; Kivik, Peeter; Oganjan, Juri; Aun, Annika; Sormus, Alar; Sarapuu, Kaili; Mall, Merilin; Karjagin, Juri; Futier, Emmanuel; Petit, Antoine; Gerard, Adeline; Marret, Emmanuel; Solier, Marc; Jaber, Samir; Prades, Albert; Krassler, Jens; Merzky, Simone; Uhlig, Christopher; Kiss, Thomas; Bundy, Anette; Bluth, Thomas; Gueldner, Andreas; Spieth, Peter; Scharffenberg, Martin; Thiem, Denny Tran; Koch, Thea; Treschan, Tanja; Schaefer, Maximilian; Bastin, Bea; Geib, Johann; Weiss, Martin; Kienbaum, Peter; Pannen, Benedikt; Gottschalk, Andre; Konrad, Mirja; Westerheide, Diana; Schwerdtfeger, Ben; Wrigge, Hermann; Simon, Philipp; Reske, Andreas; Nestler, Christian; Valsamidis, Dimitrios; Stroumpoulis, Konstantinos; Antholopoulos, Georgios; Andreou, Antonis; Karapanos, Dimitris; Theodorak, Kassiani; Gkiokas, Georgios; Tasoulis, Marios-Konstantinos; Sidiropoulou, Tatiana; Zafeiropoulou, Foteini; Florou, Panagiota; Pandazi, Aggeliki; Tsaousi, Georgia; Nouris, Christos; Pourzitaki, Chryssa; Bystritski, Dmitri; Pizov, Reuven; Eden, Arieh; Pesce, Caterina Valeria; Campanile, Annamaria; Marrella, Antonella; Grasso, Salvatore; De Michele, Michele; Bona, Francesco; Giacoletto, Gianmarco; Sardo, Elena; Sottosanti, Luigi Giancarlo Vicari; Solca, Maurizio; Volta, Carlo Alberto; Spadaro, Savino; Verri, Marco; Ragazzi, Riccardo; Zoppellari, Roberto; Cinnella, Gilda; Raimondo, Pasquale; La Bella, Daniela; Mirabella, Lucia; D'antini, Davide; Molin, Alexandre; Brunetti, Iole; Gratarola, Angelo; Pellerano, Giulia; Sileo, Rosanna; Pezzatto, Stefano; Montagnani, Luca; Pasin, Laura; Landoni, Giovanni; Zangrillo, Alberto; Beretta, Luigi; Di Parma, Ambra Licia; Tarzia, Valentina; Dossi, Roberto; Sassone, Marta Eugenia; Sances, Daniele; Tredici, Stefano; Spano, Gianluca; Castellani, Gianluca; Delunas, Luigi; Peradze, Sopio; Venturino, Marco; Arpino, Ines; Sher, Sara; Tommasino, Concezione; Rapido, Francesca; Morelli, Paola; Vargas, Maria; Servillo, Giuseppe; Raineri, Santi Maurizio; Montalto, Francesca; Russotto, Vincenzo; Giarratano, Antonino; Baciarello, Marco; Generali, Michela; Cerati, Giorgia; Leykin, Yigal; Bressan, Filippo; Bartolini, Vittoria; Zamidei, Lucia; Brazzi, Luca; Liperi, Corrado; Sales, Gabriele; Pistidda, Laura; Severgnini, Paolo; Brugnoni, Elisa; Musella, Giuseppe; Bacuzzi, Alessandro; Muhardri, Dalip; Gecaj-Gashi, Agreta; Sada, Fatos; Bytyqi, Adem; Karbonskiene, Aurika; Aukstakalniene, Ruta; Teberaite, Zivile; Salciute, Erika; Tikuisis, Renatas; Miliauskas, Povilas; Jurate, Sipylaite; Kontrimaviciute, Egle; Tomkute, Gabija; Xuereb, John; Bezzina, Maureen; Borg, Francis Joseph; Hemmes, Sabrine; Schultz, Marcus; Hollmann, Markus; Wiersma, Irene; Binnekade, Jan; Bos, Lieuwe; Boer, Christa; Duvekot, Anne; in 't Veld, Bas; Werger, Alice; Dennesen, Paul; Severijns, Charlotte; De Jong, Jasper; Hering, Jens; van Beek, Rienk; Ivars, Stefan; Jammer, Ib; Breidablik, Alena; Hodt, Katharina Skirstad; Fjellanger, Frode; Avalos, Manuel Vico; Mellin-Olsen, Jannicke; Andersson, Elisabeth; Shafi-Kabiri, Amir; Molina, Ruby; Wutai, Stanley; Morais, Erick; Tareco, Gloria; Ferreira, Daniel; Amaral, Joana; Goncalves Castro, Maria de Lurdes; Cadilha, Susana; Appleton, Sofia; Parente, Suzana; Correia, Mariana; Martins, Diogo; Monteirosa, Angela; Ricardo, Ana; Rodrigues, Sara; Horhota, Lucian; Grintescu, Ioana Marina; Mirea, Liliana; Grintescu, Ioana Cristina; Corneci, Dan; Negoita, Silvius; Dutu, Madalina; Garotescu, Ioana Popescu; Filipescu, Daniela; Prodan, Alexandru Bogdan; Droc, Gabriela; Fota, Ruxandra; Popescu, Mihai; Tomescu, Dana; Petcu, Ana Maria; Tudoroiu, Marian Irinel; Moise, Alida; Guran, Catalin-Traian; Gherghina, Iorel; Costea, Dan; Cindea, Iulia; Copotoiu, Sanda-Maria; Copotoiu, Ruxandra; Barsan, Victoria; Tolcser, Zsolt; Riciu, Magda; Moldovan, Septimiu Gheorghe; Veres, Mihaly; Gritsan, Alexey; Kapkan, Tatyana; Gritsan, Galina; Korolkov, Oleg; Kulikov, Alexander; Lubnin, Andrey; Ovezov, Alexey; Prokoshev, Pavel; Lugovoy, Alexander; Anipchenko, Natalia; Babayants, Andrey; Komissarova, Irina; Zalina, Karginova; Likhvantsev, Valery; Fedorov, Sergei; Lazukic, Aleksandra; Pejakovic, Jasmina; Mihajlovic, Dunja; Kusnierikova, Zuzana; Zelinkova, Maria; Bruncakova, Katarina; Polakovicova, Lenka; Sobona, Villiam; Novak-Supe, Barbka; Pekle-Golez, Ana; Jovanov, Miroljub; Strazisar, Branka; Markovic-Bozic, Jasmina; Novak-Jankovic, Vesna; Voje, Minca; Grynyuk, Andriy; Kostadinov, Ivan; Spindler-Vesel, Alenka; Moral, Victoria; Carmen Unzueta, Mari; Puigbo, Carlos; Fava, Josep; Moret, Enrique; Rodriguez Nunez, Monica; Sendra, Mar; Brunelli, Andrea; Rodenas, Frederic; Monedero, Pablo; Hidalgo Martinez, Francisco; Yepes Temino, Maria Jose; Martinez Simon, Antonio; de Abajo Larriba, Ana; Lisi, Alberto; Perez, Gisela; Martinez, Raquel; Granell, Manuel; Tatay Vivo, Jose; Saiz Ruiz, Cristina; de Andres Ibanez, Jose Antonio; Pastor, Ernesto; Soro, Marina; Ferrando, Carlos; Defez, Mario; Aldecoa Alvares-Santullano, Cesar; Perez, Rocio; Rico, Jesus; Jawad, Monir; Saeed, Yousif; Gillberg, Lars; Bengisun, Zuleyha Kazak; Kazbek, Baturay Kansu; Coskunfirat, Nesil; Boztug, Neval; Sanli, Suat; Yilmaz, Murat; Hadimioglu, Necmiye; Senturk, Nuzhet Mert; Camci, Emre; Kucukgoncu, Semra; Sungur, Zerrin; Sivrikoz, Nukhet; Ozgen, Serpil Ustalar; Toraman, Fevzi; Selvi, Onur; Senturk, Ozgur; Yildiz, Mine; Kuvaki, Bahar; Gunenc, Ferim; Kucukguclu, Semih; Ozbilgin, Sule; Maral, Jale; Canli, Seyda; Arun, Oguzhan; Saltali, Ali; Aydogan, Eyup; Akgun, Fatma Nur; Sanlikarip, Ceren; Karaman, Fatma Mine; Mazur, Andriy; Vorotyntsev, Sergiy; Rousseau, Guy; Barrett, Colin; Stancombe, Lucia; Shelley, Ben; Scholes, Helen; Limb, James; Rafi, Amir; Wayman, Lisa; Deane, Jill; Rogerson, David; Williams, John; Yates, Susan; Rogers, Elaine; Pulletz, Mark; Moreton, Sarah; Jones, Stephanie; Venkatesh, Suresh; Burton, Maudrian; Brown, Lucy; Goodall, Cait; Rucklidge, Matthew; Fuller, Debbie; Nadolski, Maria; Kusre, Sandeep; Lundberg, Michael; Everett, Lynn; Nutt, Helen; Zuleika, Maka; Carvalho, Peter; Clements, Deborah; Creagh-Brown, Ben; Watt, Philip; Raymode, Parizade; Pearse, Rupert; Mohr, Otto; Raj, Ashok; Creary, Thais; Chishti, Ahmed; Bell, Andrea; Higham, Charley; Cain, Alistair; Gibb, Sarah; Mowat, Stephen; Franklin, Danielle; West, Claire; Minto, Gary; Boyd, Nicholas; Mills, Gary; Calton, Emily; Walker, Rachel; Mackenzie, Felicity; Ellison, Branwen; Roberts, Helen; Chikungwa, Moses; Jackson, Clare; Donovan, Andrew; Foot, Jayne; Homan, Elizabeth; Montgomery, Jane; Portch, David; Mercer, Pauline; Palmer, Janet; Paddle, Jonathan; Fouracres, Anna; Datson, Amanda; Andrew, Alyson; Welch, Leanne; Rose, Alastair; Varma, Sandeep; Simeson, Karen; Rambhatla, Mrutyunjaya; Susarla, Jaysimha; Marri, Sudhakar; Kodaganallur, Krishnan; Das, Ashok; Algarsamy, Shivarajan; Colley, Julie; Davies, Simon; Szewczyk, Margaret; Smith, Thomas; Fernandez-Bustamante, Ana; Luzier, Elizabeth; Almagro, Angela; Melo, Marcos Vidal; Fernando, Luiz; Sulemanji, Demet; Sprung, Juraj; Weingarten, Toby; Kor, Daryl; Scavonetto, Federica; Tze, YeoBackground: The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative pulmonary complications (PPCs). Methods: LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during 'daytime' when induction of anaesthesia was between 8: 00 AM and 7: 59 PM, and as 'night-time' when induction was between 8: 00 PM and 7: 59 AM. Results: Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P = 0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P = 0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P = 0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09-1.90; P = 0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89-1.90; P = 0.15). Conclusions: Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events.Yayın Case Report Presentation of Ultrasound-guided Erector Spinae Plane Block in Shoulder Surgery: Three Patients and Two Different Results(CUREUS INC, 2018) Selvi, Onur; Tulgar, Serkan; Ozer, ZelihaErector spinae block (ESPB) is an effective therapy for chronic shoulder pain. However, ESPB has not been used as a postoperative analgesia method in shoulder surgeries. In this case report, we report three patients undergoing shoulder surgeries that received ESPB preoperatively for postoperative analgesia. All patients had relief of preoperative pain and no associated motor block. Two of the patients manifested with low maximum pain scores (4/10, 3/10) on a numeric rating scale (NRS). The other patient reported a maximum pain score of 8/10 on NRS. While this patient's shoulder mobility immediately improved after ESPB application, the ESPB did not provide adequate analgesia for the postoperative period. The use of the ESPB for acute postoperative analgesia after shoulder surgery is novel and clinically interesting. However, postoperative analgesia was not completely opioid-sparing. Consequently, the efficiency of ESPB at the level of T2 for postoperative analgesia should be considered for surgeries that involve the shoulder cap given the possible inadequate migration of local anesthetic into the cervical plexus. Clinicians should carefully consider an ESPB as a postoperative analgesic option when considering shoulder operations and the possibility for the incomplete spread of local anesthetic in targeted neural structures.Yayın Cerrahi girişimler ve immünsüpresyon(Maltepe Üniversitesi, 2014) Özer, Zeliha; Selvi, OnurCerrahi 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.Yayın Clinical experience of ultrasound-guided single and bi-level erector spinae plane block for postoperative analgesia in patients undergoing thoracotomy(ELSEVIER SCIENCE INC, 2018) Tulgar, Serkan; Selvi, Onur; Ozer, Zeliha…Yayın Clinical experiences of ultrasound-guided lumbar erector spinae plane block for hip joint and proximal femur surgeries(ELSEVIER SCIENCE INC, 2018) Tulgar, Serkan; Selvi, Onur; Senturk, Ozgur; Ermis, Mehmet Nurullah; Cubuk, Rahmi; Ozer, Zeliha…Yayın 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, ZelihaStudy 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.Yayın Effectiveness of simplified predictive intubation difficulty score and thyromental height in head and neck surgeries: an observational study(Elsevier Science Inc, 2020) Selvi, Onur; Kahraman, Seda Tuğçe; Tulgar, Serkan; Şentürk, Özgur; Serifsoy, Talat Ercan; Thomas, David; Çınar, Ayşe SurhanBackground and objectives: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. Methods: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion, and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. Results: A total of 25.4% of the patients had difficult intubations. SPIDS scores > 10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. Conclusions: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty. (C) 2020 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia.Yayın Erector spinae block in 308 patients: Complications and unexpected events(Regional Anesthesia & Pain Medicine, 2019) Tulgar, Serkan; Selvi, Onur; Thomas, David Terence; Özer, ZelihaBackground 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.Yayın Erector spinae plane block for different laparoscopic abdominal surgeries: case series(Hindawi, 2018) Tulgar, Serkan; Selvi, Onur; Kapaklı, Mahmut SertanThe ultrasound guided erector spinae plane (ESP) block is a recent block described for various surgeries for postoperative analgesia. ESP block has effect on both visceral and somatic pain; therefore, its use in laparoscopic cholecystectomy and other abdominal surgeries can be advantageous. We describe successful ESP block application in three different cases for postoperative pain. Two patient were operated on using endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy and one patient was operated on using laparoscopic cholecystectomy together with the inguinal hernia operation.Yayın Evaluation of analgesic regimens in total knee arthroplasty, retrospective study(KARE PUBL, 2017) Tulgar, Serkan; Selvi, Onur; Senturk, Ozgur; Serifsoy, Talat Ercan; Sanel, Selim; Meydaneri, SertacOBJECTIVE: Analgesic therapies have an immense role in early rehabilitation period after total knee arthroplasty (TKA) and multimodal approaches should be considered as the first choice of treatment. In this retrospective study, the aim was to evaluate the effectiveness of multimodal analgesic therapies for TKA, including femoral nerve block (FNB) and patient controlled analgesia (PCA). METHODS: The data of 79 patients who underwent TKA between January and December 2016 were retrospectively evaluated. In all, 63 patients met the inclusion criteria. Hemodynamic records and Visual Analogue Scale (VAS) pain scores for postoperative 0, 2, 4, 6, 9, and 12 hours were evaluated and patients were separated into 3 groups. Group 1: FNB with 0.25% bupivacaine, Group 2: FNB with 0.166% bupivacaine, and Group 3: No FNB. RESULTS: The average age of the patients was 64.3 +/- 14.9 years and average body mass index (BMI) was 32.5 +/- 5.3 kg/m(2). There was no statistical difference between groups in age, gender, American Society of Anesthesiologists (ASA) classification of physical health scores, BMI, or anesthesia type (p<0.05). When VAS scores at postoperative time intervals were compared, there was a statistically significant difference between Group 1 and Group 2 (p>0.05). When difference between Groups 1 and 3 and Groups 2 and 3 were compared, the difference was statistically significant for VAS 0 (p>0.05). Additional analgesic use was highest in Group 3. CONCLUSION: This study demonstrated that FNB significantly decreases postoperative pain intensity and additional analgesia requirement in patients undergoing TKA. A concentration of 0.166% bupivacaine is as effective as a concentration of 0.25% when used as part of a multimodal analgesia regimen in TKA.Yayın Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study(ELSEVIER SCIENCE INC, 2017) Selvi, Onur; Kahraman, Tugce; Senturk, Ozgur; Tulgar, Serkan; Serifsoy, Ercan; Ozer, ZelihaStudy objective: In this study we investigated and compared the predictive values of different airway assessments tests including thyromental height measurement test, which has been recently suggested, in difficult laryngoscopy (Commack and Lehane [C-L] scores 3 and 4). In addition, we compared the effectiveness of methods and C-L scores, by IDS, in terms of predicting difficult intubation. Design: Prospective, blinded study. Setting: Maltepe University. Patients: Four hundred fifty-one patients selected randomly who underwent general anesthesia. Interventions: In this study we compared predictive value of thyromental height measurement test (TMH), which has been recently suggested, modified Mallampati test (MMT), upper lip bite test (ULBT), and thyromental distance measurement test (TMD) in difficult laryngoscopy. Final C-L scores were compared with intubation difficulty scale (IDS) in terms of predicting difficult intubation. Measurements: Patient's American Society of Anesthesiology score, age and weight were recorded. TMH, TMD, MMT, ULBT, IDS and C-L scores were measured and determined. Main results: The optimal cut-off point for TMH for predicting difficult laryngoscopy was 43.5 mm and for TMD was 82.06 mm. Use of TMH <43.5 with MMT has the highest sensitivity for predicting difficult intubation (78.38) with 75.36% specificity and 97.50% negative predictive value. TMH showed sensitivity of 91.89% and specificity 52.17% at 50 mm cut-off value. In the comparison of the area under the receiver operating characteristic curve values, none of the tests came forth individually or in combination with MMT test. Conclusions: The present study demonstrates the practicality of TMH as a digitalized test however the clinical benefits of TMH in daily medical practice are drawn into question. The additional variable of race may have had some bearing on this and further studies, larger in patient sample size, may need to use different methodology concerning age-, sex-, and race -dependent variables in evaluating these tests. (C) 2016 Elsevier Inc. All rights reserved.Yayın Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial(ELSEVIER SCIENCE INC, 2018) Tulgar, Serkan; Kapakli, Mahmut Sertan; Senturk, Ozgur; Selvi, Onur; Serifsoy, Talat Ercan; Ozer, ZelihaStudy objective: Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC. Design: Single-blinded, prospective, randomized, efficiency study. Setting: Tertiary university hospital, postoperative recovery room & ward. Patients: 36 patients (ASA I-II) were recruited in two equal groups (block and control group). Following exclusion, 30 patients were included in final analysis. Interventions: Standard multimodal analgesia was performed in Group C (control) while ESPB block was also performed in Group B (block). Measurements: Pain intensity between groups were compared using Numeric Rating Scores (NRS). Also, tramadol consumption and additional rescue analgesic requirement were measured. Main results: NRS was lower in Group B during the first 3 h. There was no difference in NRS scores at other hours. Tramadol consumption was lower in Group B during the first 12 h. Less rescue analgesia was required in Group. Conclusion: Bilateral ultrasound guided ESPB leads to effective analgesia and a decrease in analgesia requirement in first 12 h in patients undergoing LC.Yayın 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, ZelihaBackground 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).Yayın FLUMAZENİL BENZODİAZEPİNLER DIŞINDAKİ ANESTEZİK AJANLARI DA ETKİLER Mİ?: OLGU SUNUMU(2015) Özer, Zeliha; Şentürk, Özgür; Selvi, OnurFlumazenil 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.Yayın Hypoxia during general anesthesia? Unknown foreign body aspiration(ELSEVIER SCIENCE INC, 2016) Senturk, Ozgur; Unal, Demet; Selvi, OnurAn 18-month-old male patient, classified as American Society of Anesthesiologists I, with bilateral inguinal hernia was scheduled for operation. Preanesthetic evaluation revealed history of completed medical treatment of acute bronchitis 10 days ago, and his respiratory examination was recorded as normal. He was successfully operated under general anesthesia with a laryngeal mask. After removal of the laryngeal mask, he displayed signs of hypoxia. Respiratory sounds were undetectable in the left thorax. He was intubated due to failure of adequate ventilation. Positive pressure ventilation and bronchodilators were administered to provide sufficient ventilation. In his chest X-ray, total atelectasis was determined in the left lung. Pleural effusion was ruled out with thoracic ultrasonography. Diagnostic rigid bronchoscopy was performed, and in left bronchial tree, hazelnut fragments were removed. The patient's hemodynamic and respiratory parameters recovered quickly after foreign body removal, and the patient was transferred to intensive care unit. His parents were questioned for persistent respiratory symptoms and they gave information about repeating respiratory tract infections in the last 3 months. We predict that displaced foreign body in lobar bronchus due to mechanical ventilation can cause this condition. (C) 2016 Elsevier Inc. All rights reserved.Yayın Koroner Arter Bypass Greft Hastalarında Pulmoner Fonksiyonlar ve Nötrofil Lenfosit Oranı Arasında Korelasyon Var mı?(2017) Bayserke, Olgar; Tulgar, Serkan; Özer, Zeliha; Selvi, OnurGİRİŞ 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.Yayın 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 TerenceThe 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.Yayın Modified thoracoabdominal nerves block through perichondrial approach (M-TAPA) provides effective analgesia in abdominal surgery and is a choice for opioid sparing anesthesia(ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Selvi, Onur; Thomas, David Terence; Deveci, Uğur; Ozer, Zeliha; Deveci, Uğur…Yayın 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, ZelihaBackground 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.
