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Yayın Anesthesiologists' Perspective on the Use of Artificial Intelligence in Ultrasound-Guided Regional Anaesthesia in Terms of Medical Ethics and Medical Education: A Survey Study(Aves, 2023) Koçer Tulgar, Yasemin; Tulgar, Serkan; Kose, Selin Güven; Kose, Halil Cihan; Nasirlier, Gülten Cevik; Dogan, Meltem; Thomas, David TerenceObjective: Controversy exists around the world as experts disagree on what artificial intelligence will imply for humanity in the future. Medical experts are starting to share perspectives on artificial intelligence with ethical and legal concerns appearing to prevail. The purpose of this study was to determine how anesthesiology and reanimation specialists in Turkey perceive the use of artificial intelligence in ultrasound-guided regional anesthetic applications in terms of medical ethics and education, as well as their perspectives on potential ethical issues.Materials and Methods: This descriptive and cross-sectional survey was conducted across Turkey between July 1 and August 31. Data were collected through an online questionnaire distributed by national associations and social media platforms. The questionnaire included questions about the descriptive features of the participants and the possible ethical problems that may be encountered in the use of artificial intelligence in regional anesthesia and 20 statements that were requested to be evaluated.Results: The average age of the 285 anesthesiologists who took part in the study was 42.00 & PLUSMN; 7.51, 144 of them were male, the average years spent in the field was 10.95 & PLUSMN; 7.15 years, 59.3% were involved in resident training, and 74.7% habitually used ultrasound guidance regional anesthetic applications. Of the participants, 80% thought artificial intelligence would benefit patients, 86.7% thought it would benefit resident training, 81.4% thought it would benefit post-graduate medical education, and 80.7% thought it would decrease complications in practice. There will be no ethical issues if sonographic data are captured anonymously, according to 78.25%, while 67% are concerned about who will be held accountable for inaccuracies.Conclusion: The majority of anesthetists believe that using artificial intelligence in regional anesthetic applications will decrease complications. Although ethical concerns about privacy and data governance are low, participants do have ethical worries about accountability for errors.Yayın Blockage of thoracoabdominal nerves through perichondrial approach (TAPA) for surgical anesthesia after failed erector spinae plane block in mini-laparatomy(ELSEVIER SCIENCE INC, 2019) Balaban, Onur; Tulgar, Serkan; Ahiskalioglu, Ali; Thomas, David Terence; Aydin, Tayfun…Yayın Can high volume pericapsular nerve group (PENG) block act as a lumbar plexus block?(ELSEVIER SCIENCE INC, 2020) Alasehir, Elcin Akduman; Ipek, Belkiz Ongen; Thomas, David Terence; Ercan, Tugba Erener; Sitar, Mustafa ErincCan high volume pericapsular nerve group (PENG) block act as a lumbar plexus block?Yayın The combination of ultrasound guided transversalis fascia plane block and transversus abdominis plane block: An alternative method for anesthesia in inguinal herniorrhaphy(ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Yilmazer, Mustafa Serdar; Kiziltunc, Bilgiser; Thomas, David Terence; Manukyan, Manuk Norayik…Yayın Comment to Santonastaso et al. 'J Clin Anesth 2019; 58: 45-46' and report of erector spinae plane block series in caesarean delivery patients(Elsevier Science Inc, 2020) Aygün, Hakan; Thomas, David Terence; Tulgar, Serkan[Abstract Not Available]Yayın Comment to Tulgar et al. 'J Clin Anesth 2018;52:34-35' and report of bilateral erector spinae plane block usage in bilateral elastofibroma dorsi(ELSEVIER SCIENCE INC, 2019) Aygun, Hakan; Akcay, Onur; Thomas, David Terence…Yayın Comparison of ultrasound guided Erector Spinae Plane Block and quadratus lumborum block for postoperative analgesia in laparoscopic cholecystectomy patients; a prospective randomized study(ELSEVIER SCIENCE INC, 2020) Aygun, Hakan; Ozturk, Nilgun Kavrut; Pamukcu, Aycin Sicakkan; Inal, Abdullah; Kiziloglu, Ilker; Thomas, David Terence; Tulgar, Serkan; Nart, AhmetStudy objective: Erector Spinae Plane Block (ESPB) is a recently described block. Both ESPB and Quadratus Lumborum block type II (QLB-II) have been reported to provide effective postoperative analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this study, we compared the postoperative analgesic effects of ESPB and QLB-II in patients undergoing LC. Design: Assessor Blinded, prospective, randomized, controlled study. Setting: Tertiary hospital, postoperative recovery room & ward. Patients: 80 patients (ASA I-II) were recruited. Patients were allocated in to two equal groups (ESB and QLB-II). All patients were included in analysis. Interventions: Standard multimodal analgesia was performed in all groups. ESPB and QLB-II were performed under ultrasound guidance. Measurements: Mean opioid consumptions and Numeric Rating Scores was measured during the first 24 postoperative hours. Main results: Demographic data was similar between groups. There was no difference between NRS scores and opioid consumption at any hour between the groups. Conclusion: While ESPB and QLB-II are not significantly different, they improve analgesia quality in patients undergoing LC.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 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 provides sufficient surgical anesthesia for ileostomy closure in a high-risk patient(ELSEVIER SCIENCE INC, 2018) Tulgar, Serkan; Thomas, David Terence; Deveci, Uğur; Deveci, Uğur…Yayın Evde kal: Covid-19 günlerinde sağlık ve iletişim stratejileri(Maltepe Üniversitesi Yayınları, 2020) Karasar, Şahin; Kök Kendirlioğlu, Burcu; Thomas, David Terence; Eroğlu, Erhan; Eyüboğlu, Ezgi; Ülger, Gürdal; Nalbant, Selim; Öztek, Zafer; Çiçek, MeltemBU DA GEÇER! 2020 yılının ilk günlerinde pandemi sözcüğünün ne anlama geldiğini tüm dünya acı kayıplar yaşayarak öğrendi. Wuhan’da ortaya çıkan COVID-19 salgını, bulaşıcılığının çok yüksek olması sebebiyle hızla tüm dünyaya yayılarak binlerce insanın yaşamını yitirmesine neden oldu. Mart 2020 ortalarında ülkemizde görülen ilk vaka ile salgın yanı başımıza geldi. Ülkemizde özverili bir çalışmayla başarıyla yönetilen pandemi günleri, hepimiz için ders alınacak günlerdi. Sağlıklı bir nefesin değerini anlamak, virüsün yuvamızdan alıp götürdüğü sevdiklerimizin acısını unutmadan ayakta kalmak, birlik ve beraberliğin gücünü ortaya koymak suretiyle birlikte başarmak… Çok şey alıp götüren bu salgın, çok şey de öğretmişti. Bâğ-ı dehrin hem hazânın hem bahârın görmüşüz Biz neşâtın da gâmın da rûzgârın görmüşüz (rüzgar:zaman, dehr: dünya, neşât: sevinçler) Klasik şiirimize hikemî üslûbu kazandıran Nâbî’nin ünlü dizelerinde dile getirdiği gibi insanoğlu dünya bahçesinin gamını, kederini yaşıyordu ama hepimiz biliyorduk ki neşâtın eli çok yakınımızdaydı. Umudu yitirmeden virüsle savaşıyordu dünya! “Bu da geçer Yâ Hû!” diyen dilimize, gönlümüz de inanıyordu! Bu kitap, salgın günlerini iletişim ve sağlık çalışmaları bağlamında mercek altına almak üzere Sayın Rektörümüz Prof. Dr. Şahin Karasar Hocamızın verdiği ilhamla kaleme alındı. Bu çalışmayla okuyucuya bir yandan Tıp gözünden salgına dair bilgi vermek, bir yandan da salgın günlerinin iletişim çalışmalarından kesitler sunmak istedik. Evde geçen günlerde benim için de adeta taze bir nefes olan kitabımızda Değerli Yazarlarımız Hocalarımız, COVID-19 mücadelesindeki yoğunluklarına rağmen davetimizi kabul ederek bu çalışmaya anlam kattılar. Ben de bir kez daha ne kadar şanslı olduğumu hissederek şükrettim. Malumumuz; şükür, her zaman nimetin kapılarını açar. Her biri alanında özel bir isim olan böylesine kıymetli Hocaların yazılarının yer aldığı bir kitabın editörlüğünü yapmak benim için büyük bir şanstır, onurdur, mutluluktur. Kelimelerle tarifi zor bir duygu... “Dil, hükmünü onu işitmeyi bilene bırakır.” diyen Lacan yardım etsin burada; gönül gözüyle görüp, işitelim... Teşekkürlerimle… Bu kitabın okuyucuyla buluşmasını sağlayan bölüm yazarlarımız Değerli Hocalarımıza en içten teşekkürü bir borç biliyorum. Sayın Rektörümüzün bizlere sunduğu bu ortak çalışma fırsatı da hem akademik açıdan hem manevi açıdan çok kıymetlidir, kendilerine de bir kez daha saygı ve şükranlarımı sunuyorum. COVID-19 salgınında hayatını kaybedenleri rahmet ve saygıyla anıyor; pandemi günlerinin bir daha geri gelmemesini temenni ediyorum. Sürç-i lisanın affıyla,Yayın Gafil avladı(Maltepe Üniversitesi, 2020) Thomas, David Terenceİnsanlık akıl almaz bir kargaşa döneminden geçiyor. Hatta Amerikalı bir yazarın deyişiyle dünya “tepetaklak” olmuş durumda. Vaka sayıları arttıkça virüsün bulaştığı insanların yaklaşık yüzde 3-4’ünün ölümüne yol açacağı düşünülüyor. Her ne kadar yüzdeye vurulduğunda bu uç bir durum gibi gözükmese de hayatını kaybedenlerin ve virüsten etkilenenlerin sayısı hesaplandığında bu çok yüksek bir sayı.Yayın Interfascial plane blocks as shortcut alternatives for regional anesthesia and pain management for SARS-CoV-2 days: Not deeper, not longer. Be safe for everyone(Elsevier, 2020) Tulgar, Serkan; Ahıskalıoğlu, Ali; Thomas, David Terence; Gürkan, YavuzDear editor, SARS-CoV-2 (COVID-19) has been a problem for the whole world since the beginning of 2020, and the war against this virus should be the top priority of all healthcare professionals. Elective surgical procedures have been delayed or significantly reduced. Many issues that were our first priority before the pandemic have now been pushed into the background. The anesthesiology community has been testing new methods for opioid sparing anesthesia and analgesia for years and setting in these methods as a principle in the protocols we chose; we cannot currently, due to the Covid-19 pandemic condemn patients to opioids [[1], [2], [3]]. In this article, we want to emphasise the main target as perioperative analgesia and chronic pain management, and we describe what we believe is the right way forward for achieving this goal. In recent years, metanalyses have been published showing that the use of interfacial blocks as part of multimodal analgesia reduces postoperative opioid requirement in surgical patients [4]. We have some suggestions in the analgesia plan of patients that are suspect of having or have been diagnosed with COVID-19.Yayın Lumbar versus thoracic erector spinae plane block: Similar nomenclature, different mechanism of action(ELSEVIER SCIENCE INC, 2018) Kose, Halil Cihan; Kose, Selin Guven; Thomas, David Terence…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.Yayın 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…Yayın A novel modification to ultrasound guided lumbar erector spinae plane block: Tulgar approach(ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Unal, Omer Kays; Thomas, David Terence; Ozer, Zeliha…Yayın Perceptions and concerns of emergency medicine practitioners about artificial intelligence in emergency triage management during the pandemic: a national survey-based study(Front. Public Health, 2023) Ahun, Erhan; Demir, Ahmet; Yiğit, Yavuz; Tulgar, Yasemin Koçer; Doğan, Meltem; Thomas, David Terence; Tulgar, SerkanObjective: There have been continuous discussions over the ethics of using AI in healthcare. We sought to identify the ethical issues and viewpoints of Turkish emergency care doctors about the use of AI during epidemic triage. Materials and methods: Ten emergency specialists were initially enlisted for this project, and their responses to open-ended questions about the ethical issues surrounding AI in the emergency room provided valuable information. A 15-question survey was created based on their input and was refined through a pilot test with 15 emergency specialty doctors. Following that, the updated survey was sent to emergency specialists via email, social media, and private email distribution. Results: 167 emergency medicine specialists participated in the study, with an average age of 38.22? years and 6.79? years of professional experience. The majority agreed that AI could benefit patients (54.50%) and healthcare professionals (70.06%) in emergency department triage during pandemics. Regarding responsibility, 63.47% believed in shared responsibility between emergency medicine specialists and AI manufacturers/programmers for complications. Additionally, 79.04% of participants agreed that the responsibility for complications in AI applications varies depending on the nature of the complication. Concerns about privacy were expressed by 20.36% regarding deep learning-based applications, while 61.68% believed that anonymity protected privacy. Additionally, 70.66% of participants believed that AI systems would be as sensitive as humans in terms of non-discrimination. Conclusion: The potential advantages of deploying AI programs in emergency department triage during pandemics for patients and healthcare providers were acknowledged by emergency medicine doctors in Turkey. Nevertheless, they expressed notable ethical concerns related to the responsibility and accountability aspects of utilizing AI systems in this context.
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