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    Assessment of the Heath Worers Knowledge About Nutrition in an University Hospital
    (Galenos Yayincilik, 2010) Inal, Mehmet Turan; Memis, Dilek; Kargi, Murat; Sut, Necdet
    Objective: Clinicians must know the definitions of malnutrition for diagnose and early treatment. This study assessed the knowledge of anesthesia residents, surgery residents and intensive care nurses about nutrition that are usually studied on the patients with malnutrition. Materials and Methods: We applied a inquiry to 80 residents and nurses working in an university hospital. The inquiry was consist of 20 questions about nutritional aspects, oral/enteral nutrition and parenteral nutrition. The one-way ANOVA, Kruskal-Wallis and chi-squre tests were used to compare variables between groups. Results: Anaesthesists group scored significantly than other groups in questions about nutritional aspects. Statistically difference was detected between anaesthesists group and intensive care nurses group (p<0.05). Surgery residents group scored more than other groups in oral/enteral nutrition questions, and statistically difference was detected between surgery residents group and surgery intensive care nurses group (p<0.05). Anaesthesists group scored significantly than other groups in questions about parenteral nutrition. Statistically difference was detected between anaesthesists group and intensive care nurses group (p<0.05). Conclusion: Knowledge about nutrition among residents and nurses was poor. Clear diagnosis and definition of nutrition and malnutrition must he defined clearly by all disciplines during training of the residents and intensive care nurses.
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    Comparison of TruView EVO2 with Miller laryngoscope in paediatric patients
    (Lippincott Williams & Wilkins, 2010) Inal, Mehmet Turan; Memis, Dilek; Kargi, Murat; Oktay, Zumral; Sut, Necdet
    Background Except for neonates and specific malformations in children, management of the paediatric airway is not a major problem for the anaesthetist. Miller laryngoscope was traditionally used for paediatric intubation. The TruView EVO2 system is a recently introduced device with a unique blade that provides a wide and magnified laryngeal view. Objective To assess the value of the TruView EVO2 laryngoscope with that of Miller laryngoscope in paediatric patients. Design Prospective analysis. Measurements and results Fifty 2-8-year paediatric patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Miller (Group M, n = 25) and TruView EVO2 laryngoscope (Group T, n = 25). Preoperative airway evaluation was performed by using the Mallampati scores. The Intubation Difficulty Scale (IDS), the duration of the tracheal intubation procedure, the rate of successful placement of the endotracheal tube in the trachea, the view of the glottis according to the Cormack and Lehane grading criteria, number of intubation attempts, mean arterial pressure (MAP) and heart rate (HR) before and after intubation, lowest peripheric oxygen saturation during intubation attempts and all complications (minor laseration, dental or other airway trauma) were all recorded. Results Preoperative Mallampati scores and the IDS scores were similar between the Miller and TruView EVO2 laryngoscope. The average time for laryngoscopy was 6.36 perpendicular to 0.99 s in group M and 13.8 perpendicular to 7.99 s in group T (P < 0.001). The TruView EVO2 laryngoscope improved the Cormack and Lehane glottic view compared with the Miller laryngoscope. The HR change (difference before and after) in group M was significantly lower than that in group T (P < 0.001). However, the MAP change was similar between groups. The lowest peripheric oxygen saturation during intubation attempts was different between groups, 99.4 +/- 0.57% in group M and 97.6 perpendicular to 2.41% in group T (P < 0.001). Conclusion The results suggest that when compared with the Miller laryngoscope, the TruView EVO2 laryngoscope appears to improve the view of the larynx but requires a longer time for tracheal intubation. The IDS scores were similar; thus, the TruView EVO2 laryngoscope can be a good alternative to traditionally used Miller laryngoscope. Eur J Anaesthesiol 2010; 27: 950-954
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    A Fatal Complication of Acupuncture in a Patient with Romatoid Arthritis: Necrotizing Fasciitis
    (Galenos Yayincilik, 2011) Colak, Alkin; Memis, Dilek; Kandulu, Hseyin; Top, Husamettin; Kargi, Murat
    Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Acupuncture is a relatively safe procedure but fatal and near fatal complications have been reported in the international literature. We report a case where fatal necrotizing fasciitis developed in a patient who had acupuncture treatment for romatoid arthritis of the knee.
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    Prognostic value of indocyanine green elimination assessed with LiMON in septic patients
    (W B Saunders Co-Elsevier Inc, 2009) Inal, Mehmet Turan; Memis, Dilek; Kargi, Murat; Sut, Necdet
    Background: Sepsis is the most frequent infection with high mortality rates in intensive care units (ICUs), and the prediction of outcome is important in the decision-making process. Objective: To assess the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and indocyanin green (ICG) plasma disappearance rate (ICG-PDR) in septic patients. Design: Retrospective analysis. Measurements and Results: We analyzed 40 septic patients (17 female and 23 male; age range, 20-89 years) who were treated in our ICU. The ICG-PDR measurement and APACHE II score measurement were made within 24 hours after admission to the ICU. Indocyanine green elimination tests were conducted concurrently using the noninvasive liver function monitoring system (LiMON, Pulsion Medical Systems, Munich, Germany). A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus. Results: Statistical analysis showed that ICG-PDR was significantly tower in nonsurvivors (n = 18) than in survivors (n = 22) (mean, 12.1% +/- 7.6%/min; median, 9%/min, vs mean, 21.2% +/- 10.1%/min; median, 20%/min, respectively [P = .004]). The area under the curve as a measure of accuracy was 0.765 for ICG-PDR and 0.692 for APACHE II. Mortality was 80% in patients with ICG-PDR below 8% per minute, and survival was approximately 89% in patients with ICG-PDR above 24% per minute. Conclusion: The results suggest that ICG-PDR, assessed with a user-friendly noninvasive bedside LiMON device, is a good predictor of survival in septic patients. Sensitivity and specificity of the noninvasive measurement of ICG-PDR on ICU admission was comparable to that obtained by APACHE II scores. (C) 2009 Elsevier Inc. All rights reserved.
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    Using temporomandibular joint mobility to predict difficult tracheal intubation
    (Springer Tokyo, 2011) Sahin, Sevtap Hekimoglu; Yilmaz, Ali; Gunday, Isil; Kargi, Murat; Sut, Necdet; Taskinalp, Oguz; Ulucam, Enis
    The aim of this prospective study was to determine the reliability of temporomandibular joint (TMJ) mobility measurements for predicting difficult intubation. To evaluate the accuracy in predicting difficult intubation by TMJ mobility measurement, 762 patients requiring general anesthesia with tracheal intubation for elective surgery were enrolled in this prospective, observational, single-blind study. Maximum mouth opening, right-left jaw excursion, and degrees of protraction were determined with a digital inclinometer. Incisor gap was measured using a vernier caliper during full mouth opening. After induction of anesthesia using a standard protocol, the patient's grade of laryngeal view by Cormack-Lehane classification was documented by an anesthesiologist. We found that the degrees of protraction and incisor gap in the easy intubation group were significantly higher than those in the difficult intubation group. The incisor gap was found to be more sensitive (88.37%) and more specific (95.71%) than protraction degrees (58.14% and 59.76%, respectively). The results revealed that measurements of the incisor gap and degrees of protraction may be useful routine screening tests for preoperative prediction of difficult intubation.