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Öğe Comparing pulse pressure variation and pleth variability index in the semi-recumbent and trendelenburg position in critically ill septic patients(Mre Press, 2017) Karadayi, Selman; Karamanlioglu, Beyhan; Memis, Dilek; Inal, Mehmet Turan; Turan, F. NesrinIntroduction. Dynamic tests for predicting fluid responsiveness have generated increased interest in recent years. One of these tests, pulse pressure variation (PPV), is a parameter calculated from respiratory variations of pulse pressure. Another test, pleth variability index (PVI), is based on respiratory variations of the perfusion index and can be measured non-invasively by pulse oximeter. Previous studies have shown that both tests are valuable in determining fluid responsiveness. Methods. In this observational prospective study, our aim was to compare the PVI and PPV in order to identify a convenient tool for determining fluid responsiveness. Our study was performed in a surgical and reanimation intensive care unit. We enrolled one hundred mechanically ventilated adult patients diagnosed with sepsis. Exclusion criteria included brain death, spontaneous breathing, cardiac arrhythmia, and impaired peripheral circulation. We measured the PPV by arterial monitorization and the PVI by using Masimo Radical 7 in the 45 degrees semi-recumbent position (SP) and then 15 degrees Trendelenbug position (TP). We performed correlation and ROC analysis using a >13% fluid responsiveness cut-off value for the PPV and >14% for the PVI. Results. Between the SP and the TP, we did not observe significant decreases in PPV (from 14.17 +/- 10.57 to 12.66 +/- 9.64; p > 0.05), while we did observe significant decreases in PVI (from 21.91 +/- 13.99 to 20.46 +/- 14.12; p < 0.05). The PPV fluid responsiveness cut-off value in the SP and TP was 20% (78.95% sensitivity, 77.05% specificity) and 18% (76.67% sensitivity, 72.46% specificity), respectively. The PVI fluid responsiveness cut-off value in the SP and TP was 20% (80.49% sensitivity, 81.03% specificity) and 16% (81.25% sensitivity, 62.69% specificity), respectively. The area under the ROC of the PPV and PVI was 0.843 and 0.858 in the SP, respectively, and 0.760 and 0.747 in the TP, respectively. The PPV and PVI were correlated in the SP (r = 0.578; p = 0.001) and the TP (r = 0.517; p = 0.001). Conclusions. Our results showed that the PPV and PVI were correlated independent of position change in sepsis patients. Both tests appear to be equivalently reliable. However, the ability of the PPV and PVI to predict fluid responsiveness decreased in the TP in our study.Öğe Effect of Preoperative Anxiety on Depth of Anaesthesia and In Vitro Fertilization Success(Galenos Publ House, 2023) Sahin, Sevtap Hekimoglu; Copuroglu, Elif; Altinpulluk, Ece Yamak; Sut, Necdet; Karamanlioglu, Beyhan; Elter, Koray; Yaman, OzgeObjective: Infertility anxiety may have a harmful effect on embryo quality and fertilization during in vitro fertilization (IVF). Monitoring brain function gives real-time information about the depth of anaesthesia of a patient. This study examined the effect of preoperative anxiety on the depth of anaesthesia and IVF success. Methods: One hundred thirty-one patients who had undergone oocyte retrieval were divided into two groups according to the Beck Anxiety Inventory (BAI): the low-anxious Group L (n = 71) and high-anxious Group H (n = 60). Hemodynamic stability, intraoperative total propofol and fentanyl consumption, good quality embryo (GQE) rate, and fertilization rate were recorded. Results: Fertilization and GQE rates were not significant between groups L and H. Total propofol consumption was significantly higher in group H than in group L. Heart rate (HR) preoperatively and postoperatively and systolic arterial pressure (SAP) preoperatively and diastolic arterial pressure (DAP) postoperatively were significantly increased in group H than in group L. The time for the modified Aldrete score to reach 9 (MAS 9) in group H was significantly higher than that in group L. The effect of variables that were found significantly in the univariate analysis (Propofol, HRpreop, HRpostop, SAPpreop, DAPpostop, and MAS 9) on BAI score. Conclusion: Total propofol consumption was higher in patients with high anxiety levels, but it did not have a negative effect on IVF success.Öğe Effects of polygeline and hydroxyethyl starch solutions on liver functions assessed with LIMON in hypovolemic patients(W B Saunders Co-Elsevier Inc, 2010) Inal, Mehmet Turan; Memis, Dilek; Karamanlioglu, Beyhan; Sut, NecdetBackground: Hypovolemia is a common clinical entity in critical patients, and adequate volume replacement therapy seems to be essential for maintaining tissue perfusion. However, it is still uncertain which solution is most appropriate for fluid resuscitation. Objective: The aim of this study was to investigate the effects of fluid resuscitation with 3.5% polygeline versus 6% hydroxyethyl starch solutions on hemodynamic functions and liver functions assessed with a noninvasive liver function monitoring system (LIMON) in hypovolemic patients. Design: This study is a prospective randomized clinical trial. Measurements and Results: Thirty hypovolemic patients (intrathoracic blood volume index, <850mL/m(2)) were randomized into hydroxyethyl starch (mean molecular weight, 130 000 Da) and polygeline (mean molecular weight, 30 000 Da) groups (15 patients each). Indocyanine green plasma disappearance elimination (ICG-PDR) were conducted concurrently using LIMON. A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus. For fluid resuscitation, 500 mL of colloid was given to the patients. Repeated hemodynamic and ICG-PDR measurements were done at baseline, after infusion, and then at 30 minutes after infusion. Results: Intrathoracic blood volume index and systolic, diastolic, and mean blood pressures increased significantly after infusion and remained elevated for 30 minutes after infusion, but there was no significant difference between the 2 groups. Indocyanine green plasma disappearance elimination values were similar in both groups with no significant difference between the two. Conclusion: Increasing intrathoracic blood volume index and hemodynamic variables by fluid loading is not associated with a significant change in ICG-PDR. (C) 2010 Elsevier Inc. All rights reserved.Öğe High C-reactive protein and low cholesterol levels are prognostic markers of survival in severe sepsis(Elsevier Science Inc, 2007) Memis, Dilek; Gursoy, Olcay; Tasdogan, Muhittin; Sut, Necdet; Kurt, Imran; Ture, Mevlut; Karamanlioglu, BeyhanStudy Objective: To evaluate serum C-reactive protein and cholesterol as a prognostic factor for Survival in patients with severe sepsis. Design: Prospective study. Setting: University hospital. Patients: The study population consisted of 96 patients (age range, 18-75 years; median, 56 years; men/women ratio, 40:56) in whom severe sepsis was diagnosed. Interventions: Patients' serum levels of C-reactive protein and cholesterol were measured upon admission to an intensive care unit, two days later, and on the day of discharge from the intensive care unit or on the day of death. Measurements and Main Results: Cholesterol levels were significantly lower among the nonsurviving patients (day 1, 92.2 +/- 25.1 mg/dL; day 2, 92.1 +/- 21.7 mg/dL; death/discharge day, 92.2 +/- 21.7 mg/dL) than surviving patients (day 1, 175.1 +/- 38.6 mg/dL [P < 0.001]; day 2, 173.0 +/- 39.3 mg/dL [P < 0.001]; death/discharge day, 171.8 +/- 39.6 mg/dL [P = 0.010]). Median C-reactive protein levels were significantly higher among the nonsurvivors (day 1, 32 mg/dL [range, 20.5-64.5 rng/dL]; day 2, 33 mg/dL [range, 22-74.5 mg/dL]; death/discharge day, 30 rng/dL [range, 22-57 mg/dL]) than survivors (day 1, 10 rng/dL [range, 6-14 mg/dL]; day 2, 9 mg/dL [range, 5-10 mg/dL]; death/discharge day, 6 mg/dL [range, 3-9 mg/dL]; P < 0.001). Conclusion: Serum C-reactive protein and cholesterol are a predictor of survival in patients with severe sepsis. Low cholesterol and high C-reactive protein levels appear as a valuable tool for individual risk assessment in severe sepsis patients and for stratification of high-risk patients in future intervention trials. (C) 2007 Elsevier Inc. All rights reserved.Öğe Premedication with gabapentin(Lippincott Williams & Wilkins, 2007) Turan, Alparslan; White, Paul F.; Karamanlioglu, Beyhan; Pamukcu, ZaferBACKGROUND: Gabapentin, an oral non-opioid analgesic, has been used to decrease pain after a variety of surgical procedures. We hypothesized that premedication with gabapentin would minimize tourniquet-related pain in patients receiving IV regional anesthesia (IVRA). METHODS: Patients undergoing elective hand surgery with IVRA were randomly assigned to one of two study groups using a double-blind study design. The control group (n = 20) received placebo capsules I h before the surgery, and the, gabapentin group (n = 20) received gabapentin 1.2 g p.o. before the operation. IVRA was achieved in all patients with lidocaine, 3 mg/kg, diluted with saline to a total volume of 40 mL. Fentanyl, 0.5 mu g/kg TV, was administered as a rescue analgesic during surgery. Sensory and motor block onset and recovery times, tourniquet pain, and quality of anesthesia were assessed at specific time intervals during the perioperative period. Visual analog scale pain scores (0-10) were recorded during the 24 h follow-up period, and patients received diclofenac, 75 mg M, if their pain score was > 4. RESULTS: The onset of the sensory and motor block did not differ between the two study groups. However, tourniquet pain scores at 30, 40, 50, and 60 min after cuff inflation were lower in the gabapentin group (P < 0.05). The time to intraoperative analgesic rescue was prolonged in the gabapentin group (35 +/- 10 min vs 21 +/- 13 min, P < 0.05), and less supplemental fentanyl was required (35 +/- 47 mu g vs 83 73 mu g, P < 0.05). The quality of anesthesia, as independently assessed by the anesthesiologist and the surgeon, was significantly better in the gabapentin (versus control) group. In the gabapentin group, the time to requesting a rescue analgesic after surgery was prolonged (135 +/- 25 min vs 85 +/- 19 min, P < 0.05), and postoperative pain scores at 60 min (3.8 +/- 0.9 vs 2.2 +/- 0.5) and 120 min (3.2 +/- 1.4 vs 1.8 +/- 0.8), as well as diclofenac consumption (30 +/- 38 mg vs 60 +/- 63 mg), were reduced after surgery. CONCLUSIONS: Premedication with oral gabapentin (1.2 g) decreased tourniquet-related pain and improved the quality of anesthesia during hand surgery under IVRA. Gabapentin also reduced pain scores in the early postoperative period.
