A Current Overview of Intensive Care Subspeciality Education in Turkey: What Do Educational Staff, Subspecialty Residents and Specialists Think?

Objective: Intensive care subspecialty programs have been opened in many medical faculties and training-research hospitals in our country, and intensivists who have graduated are working in the field. The aim of this study aimed to collect information about the status of intensive care subspecialty education and the working conditions of intensive care specialists working in the field. Materials and Methods: After obtaining the ethics committee approval, three questionnaires for intensive care subspecialty educational staff (ES), research assistants (RA), and graduated specialists (PG) were prepared through the Google Survey and published on social media. In the questionnaires, the status of education and working conditions in the field after graduation were questioned. The descriptive statistics method was used for analysis. Results: The questionnaires were answered by 38 ES, 99 RA, and 46 PG. Fifty-four percent of the ES were between the ages of 51 and 60 and 65.8% were women. Fifty-one percent of ES were working in a university hospital. Forty-seven percent of full-time ES were working in the department of anesthesiology and reanimation subdepartment of intensive care, and the rate of participation of all partner clinics in the program was 86.5%. Twenty-seven (71.1%) of the ES thought that the TUKMOS core training program should be changed. The main specialty of 54.5% of RAs were anesthesiology and reanimation, and 52% of them were studying at a state university. The rate of those who were on duty at the hospital was 87.8%, and the rate of those who described the rotation training as “medium” was 36.5%. Sixty-five percent of the PGs were anesthesiology and reanimation specialists, and 64.4% said that they would like to primarily work in training and research hospitals in terms of efficiency and qualit; 87% of them stated that intensive care specialists should be able to work in any kind of intensive care unit, 69.6% thinks that the education they receive is sufficient. Conclusion: We believe that evaluating and sharing the data of this study may cause positive changes in intensive care subspecialty education and post-graduate working conditions

A Fuzzy Inference System for Supply Chain Risk Management

Risk management is the identification, assessment, and prioritization of risks followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events. In the last decade risk management has become a vital part of supply chain management. The risk sources of supply chain are identified in five areas namely: transport/distribution, manufacturing, order cycle, warehousing, and procurement. The aim of the study is to build a supply chain risk measurement system using Fuzzy Inference Systems (FIS)

The evaluation of Qtc interval, Qtc dispersion, dysrhythmia and heart rate variability undergoing sevoflurane and desflurane anesthesia in laporoscopic surgery

Amaç: Bu çalışmada, laparoskopik kolesistektomi olgularında inhalasyon ajanı olarak kullanılan sevofluran ve desfluranın, kalp hızı değişkenliği, ritm bozukluğu QTc intervali ve QT dispersiyonu (QTd) üzerine olan etkilerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmaya elektif laparoskopik kolesistektomi planlanan 34 hasta alındı. Hastalara anestezi indüksiyonundan 15 dk. önce, peroperatif ve 30 dk.’lık derlenme süresince EKG kaydı için Holter cihazı ile monitörize edildi. Anestezi indüksiyonu 1 µg kg-1 fentanil, 4-7 mg kg-1 sodyum tiyopental ile ve kas gevşemesi 1 mg kg-1 vekuronyum ile sağlandı. Olgular, rasgele sevofluran (Grup I) ve desfluran (Grup II) olmak üzere 2 gruba ayrıldı. Hastaların etCO2, O2, N2O değerleri monitörize edildi ve etCO2 basıncı 35-40 mmHg olacak şekilde dakika ventilasyonu uygulandı. Hastaların minimal-maksimal-ortalama kalp hızları, kalp hızı değişkenliği parametreleri olan düşük frekans (LF) ve yüksek frekans (HF) ölçümleri ile LF/HF oranı, Global sempatik indeks (GSİ), R-R süreleri, preoperatif, intraoperatif, ekstübasyon 2. dakika, ekstübasyon 10. dk. ve ekstübasyon 30. dk. dönemlerinde ölçüldü. Atrial (AES) ve ventriküler (VES) aritmiler belirlendi. QT interval ölçümü Bazett formülü kullanılarak düzeltildi (QTc QT?RR). QTd, en uzun ve en kısa QT intervali bulunarak hesaplandı. Bulgular: Holter incelemelerinde, maksimal kalp hızı desfluran grubunda anlamlı yüksekti (p0.049). LF/HF, GSİ değeri indüksiyon-entübasyon evresi dışında tüm peroperatif dönemde desfluran grubunda yüksek bulundu. Peroperatuar dönemde maksimal R-R intervali sevofluran grubunda anlamlı ölçüde yüksekti. Desfluran grubunda, QTc intervali anlamlı oranda daha uzun ve QTd'de anlamlı artmış bulundu. Gruplarda, sempatik tonus artışı ile VES miktarı arasında pozitif korelasyon saptandı. Sonuç: Çalışmamızda, desfluran anestezisi sırasında sempatik aktivasyon daha fazla görülmüş ve aritmi izlenmemiştir. Ek olarak, her iki inhalasyon ajanı da QT mesafesinde uzama oluşturmasına rağmen, desfluran anestezisi altında sevofluran anestezisine göre QTc ve QTd'de anlamlı olarak artış saptandı.Introduction: The aim of the present study was to asses the effects of sevoflurane and desflurane as inhalational anaesthetics on heart rate variability, dysrhythmias, QT interval and QT dispersion in patients who will undergo laporoscopic cholecystectomy under general anaesthesia. Material and Methods: 34 patients who will undergo elective laparoscopic cholecystectomy are enrolled in the study. The patients were monitored with Holter device 15 minutes before the anaesthesia induction till 30 minutes in recovery room. Anaesthesia was induced using 4-7 mg kg-1 thiopental sodium, 1 µg kg-1 fentanyl and 1 mg kg-1 vecuronium for muscle relaxation. Cases were randomized into 2 groups; Group 1 Sevoflurane, Group 2 Desflurane. End tidal CO2, O2, N2O were monitorized and ventilation were maintained to keep EtCO2 between 30-40 mmHg. Minimum, maximum, mean heart rates and heart rate variability parameters included low frequency (LF), high frequency (HF) values which are heart rate variability parameters, LF/HF ratio, Global Sympathetic Index (GSI), R-R intervals were measured in preoperative, intraoperative periods and 2nd, 10th and 30th minutes after extubation. Atrial and ventricular dysrhythmias (AES, VES) were determined. QT interval was corrected using Bazett's formula (QTc QT?RR). QT dispersion was calculated by finding shortest and longest QT interval. Results: Assessing data from Holter Monitor maximum heart rates values were significantly higher in Desflurane group (p0.049). LF/HF ratio, GSI values were higher in Desflurane group in perioperative period except in induction-extubation events. Maximum R-R intervals in Sevoflurane group in perioperative period were significantly higher. In desflurane group QT intervals were significantly longer and QT dispersion was significantly more frequent. Positive correlation between sympathetic tonus increase and VES was recognized in both groups. Conclusion: In this study sympathetic activation was frequently seen in desflurane group. Severe dysrhythmias did not occur in both groups. Although both desflurane and sevoflurane increased the rate of QT, the increased of QTc and QTd in desflurane anesthesia were significantly higher than sevoflurane anesthesia

Yehova Şahitleri ve Travma

[No abstract available

Spinal Kord travmaları ve Anestezi

[No abstract available

Kafa travmasında anestezi

[No abstract available

Travma ve Anestezi

[No description available

The effects of lactated ringer and HES solutions in differing combinations to prevent hypotension due to spinal anesthesia

Amaç: Bu çalışmada, spinal anesteziye bağlı hipotansiyonu önlenmek için kullanılan kristaloid ve kolloid sıvılar ile, bu sıvıların farklı uygulama zamanlarının etkinliğinin araştırılması amaçlandı. Yöntem: Çalışmaya alınan ASA I-II grubu 100 hasta, beş gruba ayrıldı. Grup I'e spinal anesteziden önceki 30 dk içinde 1000 mL Ringer laktat (RL), Grup II'ye 500 mL %6 HES, Grup III'e spinal anesteziden önceki 15 dk içinde 500 mL RL ve spinal anesteziden sonraki ilk 15 dk içinde 250 mL %6 HES, Grup IV'e ve Grup Ve aynı periyodlarda sırası ile 500'mLRL + 500 mL RL, ve 250 mL %6 HES + 250 mL %6 HES uygulandı. İlk 20 dakika boyunca her dakika, daha sonra 5 dakikada bir sistolik, diyastolik, ortalama arter basınçları ve kalp atım hızları kaydedildi. Spinal uygulamadan sonraki 5., 10. ve 15. dakikalardaki duyusal blok seviyeleri tesbit edildi. Bulgular: Grup III ve IV ile grup IVveVarasında 2., 3. ve 5. dakikalardaki diyastolik arter basınçları dışında arter basınçları ve kalp atım hızları açısından fark gözlenmedi. Sonuç: Spinal anestezi sonrası hipotansiyon oluşumunda blok seviyesinin önemli olduğu, spinal anestezi öncesi kullanılan sıvıların niteliği, miktarı ve uygulama zamanı açısından bir fark olmadığı sonucuna varıldı.Objective: The aim of this study was to assess the effectiveness of preloading with crystalloid and colloid fluids on hypotension following spinal anaesthesia. Method: One hundred ASA Class I-II patients were randomly assigned to the study and divided into five groups. Group I: Lactated Ringer (LR) 1000 mL 30 minutes before spinal anaesthesia, Group II: HES %6 500 mL solution before the procedure, Group III: 500 mL RL before and HES %6 250 mL within 15 minutes after the procedure. Group IV and Group V received RL 500 mL + 500 RL mL, and HES %6 250 mL + HES %6 250 mL respectively, using the same timing protocol. Systolic, diastolic and mean arterial pressures and heart rates were measured at 1 minute intervals in the first 20 minutes and then every 5 minutes. Results: With the exception of the differences in diastolic blood pressures at the 2nd, 3rd, and 5th minutes, there was no difference in arterial blood pressures and heart rates between Group HI and IV or Group TV and V. Conclusion: While significant correlation was found between spinal block level and the incidence of spinal hypotension, no difference was observed regarding the type, dosage, and timing of loading solutions before spinal anaesthesia

Comparison of epidural ropivacaine 0.2% and ropivacaine 0.2% in combination with sufentanil 0.75 µg mL-1 for postcaesarean analgesia

Sezaryen operasyonları sonrası uygulanacak analjezi teknikleri, annelerin bebeklerinin bakımına izin verecek erken mobilizasyon ile birlikte etkin analjezi sağlamalıdır. Bu çalışmada, hasta kontrollü epidural analjezide (HKEA) kullanılan yalnız %0.2 ropivakain ve %0.2 ropivakain0.75 µg mL-1sufentanilin karşılaştırılması amaçlandı. 50 kadın olgu (ASA I) çalışmaya dahil edildi. Tüm hastalara kombine spinal-epidural anestezi uygulandı. Duyu bloğu 2 dermatom gerileyince analjezik solüsyonların infüzyonuna başlandı. Hastalar randomize olarak 2 gruba ayrıldı (n25). Grup-I’de %0.2 ropivakain ve 0.75 µg mL-1sufentanil, Grup II’ de yalnız %0.2 ropivakain kullanıldı (yükleme 1.25 mL, kilit süresi 30 dakika, 2.5 mL saat-1 infüzyon ile). Ameliyat sonrası 24 saat süresince ağrı (vizuel analog skala), motor blok (bromaj skalası) ve sedasyon (four-point skala) değerlendirildi. Hemodinamik ve solunumsal parametreler, yan etkiler, total ilaç tüketimi ve ek analjezik gereksinimi kaydedildi. İstatiksel analizde student-t, chi-square ve Mann Whitney U testleri kullanıldı. Demografik veriler, sedasyon skalaları, hemodinamik ve solunumsal parametrelerde gruplar arasında fark saptanmamıştır. Motor blok ve ağrı skorları 2 ve 4. saatte Grup-II’de anlamlı şekilde yüksek bulunmuştur. Total ilaç tüketiminin Grup-I’de 65.244.20 mL, Grup II’de 81.16.44 mL olduğu gözlenmiştir (P0.05). Grup-I’de 4 hasta, Grup-II’de 21 hasta ek analjezik kullanmıştır. Kaşıntı Grup-I’de daha fazla gözlenmiştir. Sezaryen sonrası HKEA’de %0.2 ropivakaine 0.75 µg mL-1 sufentanil eklenmesi ropivakaine göre, özellikle erken postoperatif dönemde daha etkin analjezi ve daha az motor blok sağlamıştır.Analgesic techniques after c-section must be effective producing early mobilisation to enable mothers to care effort their babies. In this study, the comparison of ropivacaine 0.2% alone, with ropivacaine 0.2%sufentanil 0.75 µg mL-1 for patient controlled epidural analgesia (PCEA) was aimed. Fifty women (ASA-I) were enrolled in the study. All patients had combined spinal-epidural anaesthesia. Infusion of analgesic solutions was started when sensory level decreased by two dermatome levels. The patients randomly assigned, into two groups (n25). In Group-I, ropivacaine 0.2% and sufentanil 0.75 µg mL-1, in Group-II, ropivacaine 0.2% alone were applied (bolus 1.25 mL, lockout 30 min, with 2.5 mL h-1 background infusion). Pain, motor blockage and sedation were evaluated during 24 hours after Caesarean, using the scales of visual analogue, bromage, and four-point, respectively. Haemodynamic and respiratory parameters, side effects, total drug consumption and additional analgesic need, were recorded. Statistical analysis included student-t, chi-square, and Mann Whitney U tests. There was no difference in demographic data, sedation scores, haemodynamic and respiratory parameters, between the groups. Motor block and pain scores were significantly higher in Group-II than in Group-I at 2 and 4. h. Total drug consumption was 65.24±4.20 mL for Group-I and 81.1±6.44 mL for Group-II, (P<0.05). Four patients in Group-I and 21 patients in Group-II received additional analgesic. Pruritus was observed more frequently in Group-I. The addition of sufentanil 0.75 µg mL-1 to ropivacaine 0.2% for PCEA after Caesarean led to more effective analgesia and less motor weakness when compared to ropivacaine 0.2% alone, especially during early postoperative period