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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 Anesthetic techniques: focus on lumbar erector spinae plane block(Dove Medical Press LTD, 2020) Tulgar, Serkan; Aydın, Muhammed Enes; Ahıskalıoğlu, Ali; De Cassai, Alessandro; Gürkan, YavuzDefined in the last decade, erector spinae plane block (ESPB) is one of the more frequently used interfacial plans, and it has been the most discussed block among the recently defined techniques. Lumbar ESPB administered at lumbar levels is relatively novel and is a new horizon for regional anesthesia and pain practice. In this article, we aim to explain and introduce different approaches and explain the possible mechanism of action of lumbar ESPB. The objective of this review is to analyze the case reports, clinical and cadaveric studies about lumbar ESPB that have been published to date. We performed a search in Pubmed and Google Scholar database. After a selection of the relevant studies, 59 articles were found eligible and were included in this review. While we believe that lumbar ESPB is reliable and easy, we suggest that its efficacy and indications should be verified with anatomical and clinical studies, and its safety should be confirmed with pharmacokinetic studies. Moreover, the possibility of complications must be considered.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 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 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 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 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 Comparison of Effects of Separate and Combined Sugammadex and Lipid Emulsion Administration on Hemodynamic Parameters and Survival in a Rat Model of Verapamil Toxicity(INT SCIENTIFIC LITERATURE, INC, 2016) Tulgar, Serkan; Kose, Halil Cihan; Piroglu, Isilay Demir; Karakilic, Evvah; Ates, Nagihan Gozde; Demir, Ahmet; Gergerli, Ruken; Guven, Selin; Piroglu, Mustafa DevrimBackground: Toxicity of calcium channel blockers leads to high patient mortality and there is no effective antidote. The benefit of using 20% lipid emulsion and sugammadex has been reported. The present study measured the effect of sugammadex and 20% lipid emulsion on hemodynamics and survival in a rat model of verapamil toxicity. Material/Methods: In this single-blinded randomized control study, rats were separated into 4 groups of 7 rats each: Sugammadex (S), Sugammadex plus 20% lipid emulsion (SL), 20% lipid emulsion (L), and control (C). Heart rates and mean arterial pressures were monitored and noted each minute until death. Results: Average time to death was 21.0 +/- 9.57 minutes for group C, 35.57 +/- 10.61 minutes for group S, 37.14 +/- 16.6 minutes for group L and 49.86 +/- 27.56 minutes for group SL. Time to death was significantly longer in other groups than in the control group (p<0.05). Conclusions: Verapamil overdose is has a comparatively high mortality rate and there is no effective antidote. Treatment generally involves gastric decontamination and symptomatic treatment to counteract the drug's negative effects. In animal studies sugammadex and lipid emulsion had a positive effect on survival in patients with calcium channel blocker toxicity. Sugammadex and intralipid increased survival in a rat model of verapamil toxicity. The combination of both drugs may decrease cardiotoxicity. Sugammadex alone or combined with 20% lipid emulsion reduce the need for inotropic agents. The mechanism requires clarification with larger studies.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 Deep supraspinatus muscle plane block: A novel ultrasound-guided technique for the blockade of suprascapular nerve branches(Elsevier Science Inc, 2021) Köse, Selin Güven; Kose, Halil Cihan; Tulgar, Serkan; Akkaya, Taylan[Abstract Not Available]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 Efficacy of bilateral erector spinae plane block in the management of pain: current insights(Dove Medical Press Ltd, 2019) Tulgar, Serkan; Ahiskalioğlu, Ali; De Cassai, Alessandro; Gurkan, YavuzErector spinae plane block (ESPB) is a newly described interfascial plane block, and the number of articles on the bilateral application of ESPB is increasing in the literature. In this paper, in addition to analyzing bilateral ESPB cases and studies published so far, we aimed to review the relevant anatomy, describe the mechanism of spread of the injectant, demonstrate varying approaches to ESPB, and summarize case reports and clinical trials, as well as provide current insight on this emerging and popular block. Randomized controlled studies, comparative studies of ESPB versus other methods, and pharmacokinetic studies of bilateral applications must be the next step in clearly understanding bilateral ESPB.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 as the main anesthetic method for peri-paravertebral area surgical procedure(ELSEVIER SCIENCE INC, 2019) Tulgar, Serkan; Yildirim, Aziz; Karaoglan, Alper; Ozer, Zeliha…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 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 Erector spinae plane block: a systematic qualitative review(EDIZIONI MINERVA MEDICA, 2019) De Cassai, Alessandro; Bonvicini, Daniele; Correale, Christelle; Sandei, Ludovica; Tulgar, Serkan; Tonetti, TommasoINTRODUCTION: The erector spinae plane (ESP) block is an interfascial block proposed to provide analgesia for chronic thoracic pain. It consists in an injection of local anesthetic in a plane between the transverse process and the erector spinae muscles group. EVIDENCE ACQUISITION: We performed a systematic review of literature following the PRISMA Statement Guidelines. The bibliographic search was conducted on September 2018. We included articles indexed in MEDLINE, EMBASE, Cochrane Library and Google Scholar. Search terms included the following: "erector spinae plane block" OR "ESP block" OR "erector spinae block." We identified 367 studies and after removal of 206 duplicates and exclusion of 18 records we manually searched 140 studies. EVIDENCE SYNTHESIS: We identified four randomized controlled trials, but the endpoints were heterogeneous preventing a statistical analysis; we performed then a qualitative review of the literature. Studies showed lower use of opioids and a longer time to first analgesic requirement in the ESP group. In one study, ESP block was found to be as effective as epidural analgesia. ESP block has a wide range of clinical indications. Its mechanism of action is still not thoroughly understood. Only two reports presented complications caused by the block. CONCLUSIONS: Although data suggests that ESP block is an easy and safe technique, more studies are needed to assess safety, complications rates and efficacy of this technique. In particular, we need well designed RCTs comparing ESP block to gold standard regional anesthesia technique. Nevertheless, ESP block is already a viable option for anesthesiologists all over the world.
