Glutaraldehidin kazara epidural uygulanmasının ağır komplikasyonu

Epidural anestezi altında sol femoropopliteal bypass uygulanan hastaya ameliyat sonrası altıncı saatte epidural kateter yoluyla kazara 3 ml %3 glutaraldehid solüsyonu uygulandı. Glutaraldehid uygulamasını takiben hastada hipotansiyon, taşikardi, bulantı ve kusma gibi sistemik semptomlara ek olarak parapleji gelişti. Bir yıllık medikal tedavi ve rehabilitasyon programı sonunda nörolojik semptomlarda iyileşme olmadı.In a patient operated for left femoropopliteal bypass under epidural anesthesia, 3 ml of 3% glutaraldehyde solution was administered through the epidural catheter at the postoperative sixth hour accidentally. Following glutaraldehyde administration, the patient developed paraplegia in addition to systemic symptoms such as hypotension, tachycardia, nausea and vomiting. At the end of the first year, neurologic symptoms didn't improve despite medical treatment and rehabilitation program

Ultrasound-guided serratus plane block combined with intercostal block for a high-risk patient with pericardial tamponade: A case report

Anesthetic management of patients with pericardial tamponade is challenging. A 65-year-old man diagnosed with small-cell lung carcinoma and bilateral malignant pleural effusion in the lungs and pericardial effusion was scheduled for pericardial-window-opening surgery. The severely compromised lung function of the patient led to an anesthetic plan of ultrasound-guided serratus anterior plane block combined with an intercostal block. Although serratus plane block was initially developed for postoperative analgesia, we have shown here that it can be used under deep sedation in combination with an intercostal block for anesthesia for surgeries involving the hemithorax; the block may be promising in high-risk cases

The Clinical Outcomes of Ultrasonography Usage in Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: A Retrospective Trial

Aim:Preprocedural ultrasonographic examination of the upper airway anatomy is an effective method for deciding on a tracheostomy procedure, such as percutaneous or surgical tracheostomy. We aimed to compare the effects of superficial cervical plexus block (CPB) with translaryngeal block with those of local anesthesia infiltration to the incision site for percutaneous tracheostomy in terms of hemodynamic parameters, gag reflex, and anesthetic requirement. In addition, we evaluated the effect of preprocedural ultrasonography assessment compared with that of anatomical landmark examination in terms of reducing the risk of procedure-related complications.Materials and Methods:A total of 148 patients aged at the range of 18-99 years, who were indicated for percutaneous tracheostomy in the intensive care unit, were enrolled in the study. The data intended for this study were obtained from the hospital’s electronic patient database through retrospective scanning between 2018 and 2022. Patients who underwent ultrasonography for the evaluation of the related anatomical structures and superficial CPB with a translaryngeal block were assigned to the ultrasonography group (n=74), whereas those who underwent an anatomical landmark technique and local anesthetic infiltration to the procedure site were assigned to the traditional group (n=74).Results:The patients’ age and sex distributions did not differ significantly between the traditional and ultrasonography groups (p>0.05). In the ultrasonography group, the preprocedural, midprocedural, and postprocedural heart rates were significantly higher than in the traditional group (p<0.05). In the ultrasonography group, the mean preprocedural arterial pressure decreased significantly during and after the procedure (p<0.05). The mean arterial pressure decreased during the procedure and the postprocedural arterial pressure was significantly higher (p<0.05) in the ultrasonography group than in the traditional group.Conclusion:Although ultrasonography-guided percutaneous tracheostomy takes more time to perform than traditional anatomical landmark percutaneous tracheostomy, we claim that the procedure is much safer and provides better clinical outcomes

Effect of waist circumference and body mass index on the level of spinal anesthesia

Background: We aimed to determine the effects of waist circumference and body mass index on spinal anesthesia levels. In total, 120 surgical patients who were between 18 and 65 years old and in the American Society of Anesthesiologists' (ASA) I-III risk groups enrolled in this study. Patients were classified into three groups, depending on their weight. After a spinal block, we noted the time needed for the sensory block to reach the T10 level, the maximum sensory block level, the time needed for the sensory block to reach the maximum sensory block level, the time needed before the start of the motor block, and the Bromage scale for each patient. Results: We observed no significant demographic differences in age, gender, or ASA risk class between the groups; however, we found a statistically significant difference between the groups' BMIs and waist circumferences. For the time needed for the spinal block to reach the T10 level, we observed a statistically significant difference between groups I, II, and III, and we also found a statistically significant difference between the groups' comparing Bromage scales. Moreover, we found a statistically significant difference between the groups' time needed (in minutes) for the block to reach the maximal upper dermatomal block level and, as BMIs and waist circumferences increased, the time needed to reach the maximal upper dermatomal block level. We also noted a statistically significant difference in waist circumference variability. Conclusions: This study shows that body mass index and waist circumference can be used and interpreted as independent parameters reflecting the increasing incidence of obesity

Ameliyathane ve Cerrahi Servis Çalışanlarının Güvenli Cerrahi Kontrol Listesine İlişkin Düşünceleri

Aim: This research is aimed at evaluating operating room and surgical ward staff’s opinions regarding the WHO surgical safety checklist. Materials and Methods: The questionnaire includes questions about gender, age, job role, and years of experience. Every item on the checklist was evaluated, and responders were permitted to provide freehand comments on the subject. The researchers visited a hospital and collected data from December 2017 - January 2018. The sample population includes 27 surgeons, 34 anaesthetists, and 19 operating room and 38 surgical ward nurses at a university hospital in western Turkey. The collected data were analysed using SPSS 18.0 with frequencies, percentages, mean, and standard deviation. Results: Of the sample population 61% were women, 47% were under 30 years old, and 83.1% had over 1 year of job experience. The mean score of item importance varied from 4.25 to 4.79. The items “patient's identity, procedure, operation site verification” (4.79±0.50) and “preoperative fasting” (4.76±0.53) had the highest scores. “Blood glucose control” (4.25±1.08) and “team members introduced” (4.32±0.53) had the lowest scores. It was suggested that “allergy” and “prophylaxis of antibiotic and deep vein thrombosis” be transferred to the “before the patients leave the ward” section. It was also suggested to add a compact checklist for local and emergency surgeries and employ artificial intelligence, like chatbots, to prevent surgery from starting before the checklist is completed. Conclusion: All checklist items were considered necessary. However, “Patient’s identity, procedure and site verification” was perceived as the most important item on the checklist. It was also suggested to add a compact checklist for local and emergency surgeries.Amaç: Bu araştırmanın amacı, ameliyathane ve cerrahi servis çalışanlarının DSÖ Güvenli Cerrahi Kontrol Listesine ilişkin düşüncelerini belirlemektir. Materyal ve Metot: Bu çalışma tanımlayıcı bir anket çalışmasıdır. Araştırma, Aralık 2017-Ocak 2018 tarihleri arasında, bir üniversite hastanesinde görev yapan 27 cerrah, 34 anestezist, 19 ameliyathane ve 38 cerrahi servis hemşiresi olmak üzere, 118 kişiyle gerçekleştirildi. Veriler cinsiyet, yaş, meslek, çalışma deneyimi gibi soruları içeren yapılandırılmış bilgi formu ve Güvenli Cerrahi Kontrol Listesi kullanılarak toplandı. Çalışanlar, Güvenli Cerrahi Listesindeki her bir maddenin önemini 5’li likert ölçek üzerinde değerlendirdi ve açık uçlu sorular aracılığıyla listeye ilişkin yorumlarda bulundu. Elde edilen veriler SPSS 18.0 paket programı ile yüzdelik, sıklık, ortalama ve standart sapma kullanılarak değerlendirildi. Bulgular: Örneklem grubunun %61’i kadın, %47’si 30 yaşın altında, %83,1’i 1 yıldan fazla mesleki deneyime sahiptir. Maddelerin önem derecelerinin ortalamaları 4.25 ile 4.79 arasında değişmektedir. ’Hastanın kimlik bilgilerinin, ameliyatının ve bölgesinin doğrulanması’’ (4.79±0.50) ve ‘’hasta aç mı’’ (4.76±0.53) en önemli görülen maddeler olurken, ‘’Kan şekeri kontrolü gerekli mi?’’ (4.25±1.08) ve ‘’Ekipteki kişiler kendilerini ad, soyad ve görevleri ile tanıttı mı?’’ (4.32±0.53) maddelerdi ise en önemsiz algılanan maddelerdi. Çalışanlar, ‘’Hastanın bilinen bir alerjisi var mı? ve ‘’Derin ven trombozu ve antibiyotik profilaksisi sorgulandı mı?’’ maddelerinin listenin ‘’klinikten ayrılmadan önce’’ kısmında kontrol edilmesini önerdi. Ayrıca çalışanlar, lokal ve acil cerrahi girişimler için daha kısa bir kontrol listesinin oluşturulmasını ve kontrol listesi tamamlamadan ameliyatın başlamasını önleyecek sohbet botları gibi yapay zeka ürünlerinin kullanılmasını önerdi. Sonuç: Çalışanlar, Güvenli Cerrahi Kontrol Listesinde yer alan tüm maddelerin önemli olduğunu düşünmektedir. Bununla birlikte, “Hastanın kimlik bilgilerinin, ameliyatının ve ameliyat bölgesinin doğrulanması” kontrol listesindeki en önemli madde olarak algılandı. Ayrıca, lokal ve acil cerrahi girişimler için daha kısa bir kontrol listesinin oluşturulması önerildi

A 5-year surveillance of healthcare-associated infections in a university hospital: A retrospective analysis

Objectives: Nosocomial infections or healthcare-associated infections are a significant public health problem around the world. This study aimed to assess the rate of laboratory-confirmed healthcare-associated infections, frequency of nosocomial pathogens, and the antimicrobial resistance patterns of bacterial isolates in a University Hospital. Methods: A retrospective evaluation of healthcare-associated infections in a University Hospital, between the years 2015 and 2019 in Tekirdag, Turkey. Results: During the 5 years, the incidence densities of healthcare-associated infections in intensive care units and clinics were 10.31 and 1.70/1000 patient-days, respectively. The rates of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections in intensive care units were 11.57, 4.02, and 1.99 per 1000 device-days, respectively. The most common healthcare-associated infections according to the primary sites were bloodstream infections (55.3%) and pneumonia (20.4%). 67.5% of the isolated microorganisms as nosocomial agents were Gram-negative bacteria, 24.9% of Gram-positive bacteria, and 7.6% of Candida. The most frequently isolated causative agents were Escherichia coli (16.7%) and Pseudomonas aeruginosa (I 5.7%). The rate of extended-spectrum beta-lactamase production among E. coli isolates was 51.1%. Carbapenem resistance was 29.8% among isolates of P. aeruginosa, 95.1 % among isolates of Acinetobacter baumannii, and 18.2% among isolates of Klebsiella pneumoniae. Colistin resistance was 2.4% among isolates of A. baumannii. Vancomycin resistance was 5.3% among isolates of Enterococci. Conclusion: Our study results demonstrate that healthcare-associated infections are predominantly originated by intensive care units. The microorganisms isolated from intensive care units are highly resistant to many antimicrobial agents. The rising incidence of multidrug-resistant microorganisms indicates that more interventions are urgently needed to reduce healthcare-associated infections in our intensive care units

COVID-19 Pandemi Sırasındaki Acil Cerrahi Bakım ve Ameliyathane Uygulamalarında Perioperatif Uygulama ve Rehberlik; Deneyimlerimiz

Aim: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). We aimed to review the latest data on the COVID-19 pandemic and essential information for practice in emergency surgery and the operating room.Materials and Methods: An interventional platform (operating room, interventional suite, and endoscopy) with our committee formed with our doctors consisting of different branches, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. We aimed to share our experiences with 128 patients who were taken into operation in a 2-month period.Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in Medical Faculty of Namık Kemal University.Results: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on the urgency of operation, anticipated viral burden at the surgical site, the opportunity for a procedure to aerosolize virus, and the likelihood a patient could be infected based on symptoms and testing.Conclusion: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.Amaç: Yeni koronavirüs SARS-CoV-2 (COVID-19) sağlık çalışanlarını enfekte edebilir. COVID-19 salgını sırasında ameliyathane ekip üyelerini korumak ve rasyonel olarak kişisel koruyucu ekipman (KKE) için kurumsal bir algoritma geliştirdik. Acil cerrahi ve ameliyathanede COVID-19 salgını ile ilgili en güncel bilgileri gözden geçirmeyi amaçladık. Materyal ve Metot: Farklı branşlardan oluşan doktorlarımızla oluşturduğumuz komitemiz ile girişimsel bir platform (ameliyathane, girişimsel ve endoskopi), potansiyel yayılma örüntüleri, maruz kalma riski ve KKE'nin korunmasına dayanan kılavuzlarımızı geliştirdik. Deneyimlerimizi 2 aylık bir sürede ameliyat edilen 128 hasta ile paylaşmayı amaçladık. 2019-nCoV şüphesi olan hastalar için acil durum prosedürleri için anestezi yönetimi ve enfeksiyon kontrol kılavuzları Namık Kemal Üniversitesi Tıp Fakültesi'nde hazırlanmış ve uygulanmıştır. Bulgular: Ameliyathane ekibi üyelerine yönelik önlemler için kurumsal yönergelerimizi açıklayan bir karar algoritması oluşturuldu. Bu algoritma ameliyatın aciliyetine, cerrahi bölgede beklenen viral yüke, virüsü aerosol haline getirme prosedürü fırsatına ve hastanın semptomlara ve testlere dayanarak enfekte olma olasılığına dayanır. Sonuç: COVID-19'un yeni bir tehdit olmasına rağmen, girişimsel platform ekipleri için izlemesi kolay bir karar algoritması geliştirerek, optimum sağlık çalışanı güvenliğini sağlayabildiğimizi gösterdik

Predictive Values of Inflammation Indexes in Predicting Mortality in Patients with COVID 19 Hospitalized in General Intensive Care Unit

Objective: Causing a global pandemic, the coronavirus disease 2019 (COVID-19) has caused millions of people to become infected and many more to die. In this study we aimed to investigate whether routinely evaluated clinical and laboratory values ??can predict the mortality of patients with COVID-19 disease.Materials and Methods: In our study, routine laboratory parameters of 89 patients hospitalized in the general intensive care unit with the diagnosis of COVID 19 were retrospectively analyzed. The aggregate index of systemic inflammation (AISI) and other inflamatuar values were calculated from blood tests in patients with positive COVID-19 polymerase chain reaction test and with ground-glass opacity on lung tomography. Patients were divided into two groups as those who died (non-survivors) and those who were discharged (survivors)during the intensive care follow-ups. Results: In our study, in 48 patients who died during follow-up, the indexes of AISI, other inflamatuar paramaters and the biochemical parameters such as troponin I, d-dimer, ferritin and procalcitonin were significantly higher than in discharged patients. Hypertension and higher AISI and ferritin levels were statistically associated with reduced survival in Cox regression analysis (Hazard ration (HR): 3.176; 95% Confident interval (CI): 1.122-8.991, p=0.03, HR: 1.114; 95% CI: 1.060-1.348, p=0.042, HR=1.072;95% CI: 1.014-1.242, p=0.011, respectively.Conclusion: Inflammation indexes derived from blood tests and acute phase reactants such as ferritin can guide us in planning the treatment strategy and risk stratification in patients with COVID-19 in intensive care follow-ups.

Continuous spinal anesthesia application in a patient with high cardiac risk: Case report

Alt ekstremite cerrahisi anestezisinde, genel anesteziden çok rejyonel yöntemler tercih edilmektedir. Özellikle yaşlı ve yüksek kardiyak riskli hastalarda hemodinamik stabiliteyi koruyarak yeterli anestezi sağlanması temel amaçtır. Acil sağ diz üstü amputasyon planlanan 63 yaşındaki kadın hasta, altı gün önce ST yükselmesiz miyokard infarktüsü (Mİ) tanısı konularak tedavi edilmişti. Olgunun 15 yıldır tip 2 diabetes mellitusu, 10 yıldır hipertansiyonu vardı. İki yıl önce iki damar baypas ile mitral annuloplasti ve iki ay önce sağ diz altı amputasyon uygulanmıştı. Sağ lateral pozisyonda, L3-4 intervertebral aralıktan kateter içinden iğne tekniği ile intratekal kateter yerleştirildi. Serbest BOS akışı görüldükten sonra 2.5 mg %0.5'lik bupivakain uygulandı. Yeterli duyusal blok seviyesi sağlanana kadar her beş dakikada bir tekrarlanan 2.5 mg'lık dozlarla toplam 7.5 mg %0.5 bupivakain uygulanarak anestezi sağlandı. Duyusal blok T10 seviyesine ulaştıktan sonra sırtüstü pozisyon verildi. Ameliyat süresince hemodinamik olarak stabil seyreden olguya kateterden ek ilaç uygulanmadı ve bir saatlik ameliyat sonunda spinal kateteri çıkarılarak servise gönderildi. Sonuç olarak, özellikle yaşlı ve kardiyak riski yüksek olgularda alt ekstremite ameliyatları için sürekli spinal anestezi tekniğinin uygun bir anestezi seçeneği olarak kullanılması gerektiğini düşünmekteyizRegional techniques are preferred to general anesthesia in lowerextremity surgery. Especially in elderly patients with high cardiac risk, the main objective is to supply sufficient anesthesia preserving hemodynamic stability. A 63-year-old female patient in whom emergency right leg amputation above the knee was planned, was treated for myocardial infarction without ST elevation 6 days ago. She had type 2 diabetes mellitus for 15 years, and hypertension for 10 years. She underwent a coronary bypass operation for two vessels and mitral annuloplasty two years ago and right leg amputation below the knee two months ago. An intrathecal cathater was placed at the right lateral position from L3-4 intervertebral space through the cathater by the needle technique. After cerebrospinal fluid flow was observed, we administered 2,5 mg 0.5% bupivacaine. Anesthesia was maintained by performing 2.5 mg of bupivacain every five minutes at a total dose of 7.5 mg until adequate sensory block was reached. The patient was given a supine positione after the sensory block reached T10 level. The patient was hemodynamically stable during the operation and did not require additional drug from the catheter. The patient was sent to the ward after removing spinal cathater at the end of a one hour operation. In conclusion, especially in old patients with high cardiac risk, we think that continuous spinal anesthesia should be the method of choice for anesthesia in lower-extremity surgery