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The assessment of QT intervals in acute carbon monoxide poisoning
(Turkish Soc Cardiology, 2009) Yelken, Birguel; Tanriverdi, Belkis; Cetinbas, Ferda; Memis, Dilek; Sut, Necdet
Objective: Carbon monoxide (CO) poisoning is known to cause myocardial toxicity and life threatening arrhythmias. QT interval measured from electrocardiogram is an indirect measure of the heterogeneity of ventricular repolarization, which may contribute to ventricular arrhythmias. The purpose of the study was to investigate whether the carboxyhemoglobin (COHb) level may be related to the changes of QT, corrected QT (QTc), (IT dispersion (QTd), corrected Qtd (QTdc) and cardiac enzymes during carbon monoxide poisoning. Methods: We conducted an observational study; 104 patients who had been diagnosed with CO intoxication were included in the study. Measurement of QT, QTc, QTd and QTdc intervals were performed form electrocardiogram on admission, 24 and 48 hours after admission. Cardiac enzymes were measured at each time-point. The myocardial perfusion scan was determined in all patients I week after admission. Results: The QT interval level in 24h was significantly higher than admission level (p<0.001), additionally QTc interval levels in 24h and 48h were significantly lower than admission levels (p<0.001 and p<0.001, respectively). Carboxyhemoglobin level only significantly correlated with QT intervals (r=-0.288; p=0.019), troponin T (r=-0.297; p=0.007), and creatine kinase MB levels (r=0.262; p=0.020). As a result of ROC analysis the QT interval level was significantly powerful parameter to predict COHb (p=0.022). Conclusion: Our data indicate COHb level correlated with QT intervals and cardiac enzymes. Clinicians should possibly avoid QT prolonging drugs and carefully monitor the QT, QTc, QTdc intervals in patients at high risk of cardiac disability due to high levels of COHb after CO poisoning. (Anadolu Kardiyol Derg 2009; 9: 397-400)
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.
Barotrauma during apnea testing for brain death. Barotrauma and apnea testing
(Reial Acad Medicina Illes Balears, 2022) Inal, Mehmet Turan; Memis, Dilek; Ceritoglu, Ece Burcak; Karakas, Hilal; Simsek, Osman; Yanik, Fazli
The apnea test is used for the diagnosis of brain death. Various complications have been reported to have developed during the apnea test. A 44-year-old woman was hospitalized in the intensive care unit due to unconsciousness due to a posterior inferior carotid artery aneurysm. On the forty-ninth day of her hospitalization in the intensive care unit, the patient had no motor response and all brain stem reflexes were negative. Brain death was considered in the patient, but subcutaneous emphysema and bilateral pneumothorax developed within minutes during the apnea test. The patient underwent bilateral tube thoracostomy. The patient could not be diagnosed with brain death and died on the fiftieth day of her hospitalization. This report emphasizes that multiple complications can be observed during the apnea test and underlying mechanisms and therapeutic approaches are discussed.
Characteristics of Pseudomonas aeruginosa isolates from intensive care unit
(De Gruyter Poland Sp Z O O, 2009) Ozer, Burcin; Tatman-Otkun, Muserref; Memis, Dilek; Otkun, Metin
The study looked at the antimicrobial resistance patterns, serotypes, molecular types, metallo beta-lactamase, and chromosomal betalactamase enzymes of P. aeruginosa strains isolated from the patients and the staffs of the intensive care unit. P. aeruginosa isolates from the patients as nosocomial pathogens and from the staffs were evaluated for their susceptibilities to the antimicrobials by the disk diffusion and E-test methods. Metallo beta-lactamase enzymes were investigated by E-test, the inducibility of beta - lactamase enzymes were detected by the disk antagonism test. Serotyping was performed by slide agglutination method. The P. aeruginosa isolates were typed by pulsed field gel electrophoresis. Twenty-five P. aeruginosa strains from the patients and three from the staffs were isolated. Fifteen P. aeruginosa, eleven of which composed of MDR bacteria, were found in serogroup E, 7 strains in G, 4 strains in B, and 1 strain in serogroup A. In all 12 bacteria in the MDR and serogroup E, metallo beta-lactamase enzyme was found to be positive. And in other 15 strains, except the bacterium which could not be serotyped, chromosomal beta-lactamase was found to be positive. The result of the molecular typing showed PFGE A pattern. In conclusion, a pattern in PFGE which included bacteria from MDR and serogroup E, G which was observed in the P. aeruginosa strains which was isolated from the staff's hands and from the 5 patients, and PFGE F pattern were found to be observed the most. Finally, the two different clonal strains were found to be established in the intensive care.
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. Nesrin
Introduction. 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.
Comparison of different tests to determine difficult intubation in pediatric patients
(Elsevier Science Inc, 2014) Inal, Mehmet Turan; Memis, Dilek; Sahin, Sevtap Hekimoglu; Gunday, Isil
Background: The difficulties with airway management is the main reason for pediatric anesthesia-related morbidity and mortality. Objective: To assess the value of modified Mallampati test, Upper-Lip-Bite test, thyromental distance and the ratio of height to thyromental distance to predict difficult intubation in pediatric patients. Design: Prospective analysis. Measurements and results: Data were collected from 5 to 11 years old 250 pediatric patients requiring tracheal intubation. The Cormack and Lehane classification was used to evaluate difficult laryngoscopy. Sensitivity, specificity, positive predictive value and AUC values for each test were measured. Results: The sensitivity and specificity of modified Mallampati test were 76.92% and 95.54%, while those for ULBT were 69.23% and 97.32%. The optimal cutoff point for the ratio of height to thyromental distance and thyromental distance for predicting difficult laryngoscopy was 23.5 (sensitivity, 57.69%; specificity, 86.61%) and 5.5 cm (sensitivity, 61.54%; specificity, 99.11%). The modified Mallampati was the most sensitive of the tests. The ratio of height to thyromental distance was the least sensitive test. Conclusion: These results suggested that the modified Mallampati and Upper-Lip-Bite tests may be useful in pediatric patients for predicting difficult intubation. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
Comparison of extubation times between protocolized versus automated weaning systems after major surgery in the intensive care unit
(Pharmamed Mado Ltd, 2012) Inal, Mehmet Turan; Memis, Dilek; Yildirim, Ilker
Background. Prolonged mechanical ventilation is associated with adverse clinical outcomes for critically ill patients. Objective. To assess the the extubation times of protocolised versus automated weaning systems in patients after major surgery in intensive care unit. Design. Retrospective analysis. Measurements and results. We analyzed 70 patients with major abdominal or pelvic surgery. Patients that were used Draeger Evita2 Dura for weaning process named as the C (control) group (n=35) and patients that were used Draeger Evita2 XL Smartcare/PS named as the SC group (n=35). A physician evaluate the patient every 5 or 10 minutes in group C. Gender, age, weight, operation time, operation type, the total volume of intravenous infusion, bleeding, total dose of propofol, fentanyl citrate, rocuronium during surgery and extubation time were all recorded. All side effects included reintubation, bleeding, stroke, death, postoperative myocardial infarction were all recorded. The partial oxygen pressure (Pa02) and partial carbondioxide pressure (PaC02) were recorded before and after extubation. Results. Demographic data and operative data were similar between groups (p>0.05). The extubation time was similar between groups (SC group versus C group: 191,14+/-79,1 min versus 188,29+/-51,47 min, p=0,534. There was significant decrease in arterial PO2 and increase in arterial PCO2 after extubation in all groups. No side effects were observed. Conclusion. In conclusion, although we found no differences between SmartCare and control groups, the evaluating of the patient increased the workload in the control group. We think that SmartCare decreased the workload. Thus, it can be recommended for weaning process of patients after major surgery in intensive care unit.
COMPARISON OF TRUVIEW EVO2 LARYNGOSCOPE WITH MACINTOSH LARYNGOSCOPE ON PATIENTS UNDERGOING CAESAREAN SECTION
(Nobel Ilac, 2016) Inal, Mehmet Turan; Memis, Dilek; Yandim, Tarik; Ersoz, Sule
Objective: A significant part of developing complications from anaesthesia during caesarean section is related to airway management. The goal of this study was to determine the efficiency of the TruView EVO2 laryngoscope compared with the Macintosh laryngoscope on patients undergoing caesarean section. Material and Method: One hundred patients requiring endotracheal intubation for caesarean delivery were divided into two groups: Group T, using the TruView EVO2 laryngoscope (n=50), and Group M, using the Macintosh laryngoscope (n=50). The view of the glottis evaluating Cormack-Lehane classification, the intubation time, the success rate, the number of intubation attempts, the blood on blade, minor laceration, dental/airway trauma, and the lowest peripheral oxygen saturation during intubation attempts were noted. Results: The view with the TruView EVO2 laryngoscope was better than the view with the Macintosh laryngoscope, using the Cormack-Lehane classification (p<0.05) for evaluation. The intubation time was 6.0 +/- 1.9 sec in group M and 13.8 +/- 3.3 sec in group T (p<0.001). The success rate was 100% in all groups. The number of intubation attempts was 46/2/2 in group T and 45/3/2 in group M (p>0.05). Blood on blade was detected in five patients in group T and in four patients in group M. Minor laceration was detected in four patients in group T and in three patients in group M. No statistically difference was detected in the incidence of complications. The lowest peripheral oxygen saturation during intubation attempts was 99.14 +/- 0.67 in group T and 99.00 +/- 0.72 in group M (p>0.05). Conclusion: The TruView EVO2 laryngoscope provides better laryngeal views and similar peripheral oxygen saturations and complication rates when compared with the Macintosh laryngoscope; thus, it can be used for intubation in obstetric patients.
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
Curcumin attenuates the organ dysfunction caused by endotoxemia in the rat
(Elsevier Science Inc, 2008) Memis, Dilek; Hekimoglu, Sevtap; Sezer, Atakan; Altaner, Semsi; Sut, Necdet; Usta, Ufuk
Objective: Curcumin has antioxidant, antitumor, and anti-inflammatory properties. However, it remains unknown whether curcumin has any protective effects on sepsis. The purpose of this study was to demonstrate whether curcumin prevents organ dysfunction in animals with sepsis. Methods: Rats were randomized into four groups. The control group (group I, n = 7) did not receive any treatment. The curcumin group (group II. n = 10) only received 1.2 g/kg of curcumin. Escherichia coli were injected into the remaining groups intraperitoneally after general anesthesia. Five hours after injection, 12 rats received placebo (group III), and 10 rats received 1.2 g/kg of curcumin (group IV) for 7 d. All rats were sacrificed on postsepsis day 8 and it midline laparotomy was performed. Livers, kidneys, and small bowels were excised for evaluation of the degree of inflammation and tissue alterations histopathologically. Results: In the liver, widespread hydropic degeneration of hepatocytes were seen in the sepsis group. There was no hydropic degeneration of hepatocytes and no portal inflammation ill the sepsis/curcumin group. With respect to the small bowel, the sepsis group showed edema and prominent intraepithelial infiltration of neutrophil leucocytes and plasma cells. Inflammation and hyperemia in the lamina propria in the sepsis/curcumin group were less than those in the sepsis group, With respect to the kidneys, the sepsis group showed severe acute tubular necrosis that was more restricted in the sepsis/curcumin group than in the sepsis group. Conclusion: curcumin reduced organ dysfunction in rats with experimentally formed sepsis. We propose that curcumin may he useful in the therapy of organ dysfunction due to sepsis, shock, and other diseases associated with local or systemic inflammation. (C) 2008 Elsevier Inc. All rights reserved.
Determining the efficiency of different malnutrition tests in septic patients
(Reial Acad Medicina Illes Balears, 2021) Inal, Mehmet Turan; Memis, Dilek; Tek, Seyda Cigdem; Uyar, Ahmet Senol; Ozel, Muhammet Fatih; Ciftci, Taner; Turan, Fatma Nesrin
Background and aims: Malnutrition is frequently detected in septic patients and is important cause of mortality. Methods: Numerical rating Scale 2002, Nutrition risk in the critically ill score and adductor pollicis thickness measurement are used to determine malnutrition in 287 septic patients. Results: The mean age was 66,57 +/- 16,31 years. The mean APACHE II score was 16,19 +/- 8,20 while the mean SOFA score was 5,89 +/- 3,49. To NRS 2002 test 171 was accepted as high malnutrition risk while 116 patients was accepted as low malnutrition risk. According to Nutric test, the risk of malnutrition was found to be low in 144 patients and found to be high in 143 patients. The mean APTM was detected as 20,20 +/- 2,21 mm. The cuff-off point for APTM was found as <= 21 mm. Conclusions: high risk of malnutrition was frequently observed in patients with sepsis and mortality was higher in high risk patients. Higher sensitivity was achieved when the tests were combined with each other. As a result, we recommend the use of malnutrition screening tests in patients with sepsis and combining the tests with each other.
Duodenal necrosis during nasogastric tube feeding: A case report
(Ekin Tibbi Yayincilik Ltd Sti-Ekin Medical Publ, 2007) Memis, Dilek; Sahin, Sevtap Hekimoglu; Sezer, Atakan
A case of duodenal necrosis during nasogastric tube feeding in a 45-year-old male patient hospitalized in intensive care unit with a diagnosis of acute respiratory distress syndrome is reported with a review of literature. Abdominal distension developed after several days of uneventful nasogastric tube feeding. At laparotomy patchy necrosis of the duedonum was found without signs of bowel obstruction or impaired mesenteric perfusion. In this case, the large doses of fentanyl, midazolam and dopamine given for sedation, were suspected to be a major contributing factor to the development of the necrosis by impairing mucosal per-fusion.
The effect of dexmedetomidine on liver histopathology in a rat sepsis model: an experimental pilot study
(Turkish Assoc Trauma Emergency Surgery, 2010) Sezer, Atakan; Memis, Dilek; Usta, Ufuk; Sut, Necdet
BACKGROUND In this pilot study, we aimed to investigate the effect of dexmedetomidine on liver tissues during experimental sepsis by histopathological examination. METHODS The animals were allocated randomly to four groups, two of which received endotoxin. In the Sepsis Group (n:10) and Dexmedetomidine/Sepsis Group (n:10), endotoxemia was induced by E. coli lipopolysaccharide derived from E. colt 0111: B4. Animals in the Control Group (n:10) received an infusion of 0.9% saline (1.0 mL.kg(-1).hr(-1)) intravenously. The Dexmedetomidine Group (n:10) and Dexmedetomidine/Sepsis Group received a bolus injection of 0.9% saline (1.0 mL/kg), followed by dexmedetomidine administration (infusion at 5 mu g.kg(-1).hr(-1)). All rats were euthanized at the 8th hour of endotoxin infusion. Histopathological examinations were performed on liver tissues. RESULTS In the liver, central venous congestion, congestion and dilation of the hepatic sinusoids and inflammation of the portal tracts were noted in the Sepsis Group. These parameters were seen slightly in the Sepsis/Dexmedetomidine group. There was a statistically significant difference between the Sepsis and Sepsis/Dexmedetomidine Groups (p<0.001). CONCLUSION Dexmedetomidine has a protective effect on liver tissues during experimental sepsis in the rat. We propose that dexmedetomidine sedation may be useful in the therapy of the liver dysfunction associated with sepsis and in other diseases related to local or systemic inflammation.
Effect of Proton Pump Inhibitors on Gastric Juice Volume, Gastric pH and Gastric Intramucosal pH in Critically Ill Patients A Randomized, Double-Blind, Placebo-Controlled Study
(Adis Int Ltd, 2008) Gursoy, Olcay; Memis, Dilek; Sut, Necdet
Objective: This study aimed to determine the effect of administration of a single-dose proton pump inhibitor (PPI) on gastric intramucosal pH (pHi), gastric juice volume and gastric pH in critically ill patients. Methods: This prospective, randomized, double-blind, placebo-controlled study included 75 patients who were divided into five groups that received the following treatment: group C (n = 15), saline 100 mL; group 0 (n = 15), omeprazole 20 mg; group P (n = 15), pantoprazole 40 mg; group E (n = 15), esomeprazole 20 mg; and group R (n = 15), rabeprazole 20 mg. All treatments were administered nasogastrically in 100 mL of physiological saline. Measurements of gastric pHi, gastric juice volume and gastric pH were obtained immediately before and 2, 4 and 6 hours after administration of treatments. In addition, gastric content was aspirated and its volume was recorded. Results: Initial gastric pHi, gastric juice volume and gastric pH values were not statistically significantly different among the groups (p > 0.05). No statistically significant difference in gastric pHi was seen among the groups before or 2, 4 or 6 hours after saline or PPI administration. At hours 2, 4 and 6, gastric pH in the pantoprazole, esomeprazole and rabeprazole groups increased significantly, whereas gastric juice volume decreased significantly, compared with the omeprazole and placebo groups (p < 0.001). No statistically significant differences were seen between the pantoprazole, esomeprazole and rabeprazole groups. Conclusion: This is the first study to show that single-dose pantoprazole, esomeprazole and rabeprazole are associated with greater gastric pH increase and greater gastric juice volume decrease than omeprazole in critically ill patients. Our study also suggests that PPIs do not affect gastric pHi measurements in critically ill patients and can be administered during pH monitoring.
The effect of the prebiotic solutions in treatment of severe sepsis
(Aves Yayincilik, Ibrahim Kara, 2007) Memis, Dilek; Yelken, Birguel; Sahin, Sevtap Hekimoglu; Vatan, Ilke; Yardim, Tarik
Objectives: In this double blind, prospective and randomized study, the effects of the enteral administration of a prebiotic preparation containing oligofructose and inulin on upper gastrointestinal colonization and systemic inflammation in intensive care patients with severe sepsis were investigated. Patients and Methods: A total of 50 patients admitted to an intensive care unit were randomized to receive either prebiotic (group 1, n=25) or placebo preparations (group 2, n=25). The prebiotic preparation consisted of prebiotic fiber inulin-oligofructose (0.8 g/100 mL, A, D3, E vitamins). Gut barrier function was assessed by culture of nasogastric aspirate on the first and eighth days. All septic complications, acute physiology and chronic health evaluation II (APACHE II) scores, ventilation days, gastrointestinal culture results, biochemical parameters, C-reactive protein (CRP) and mortality ratios were recorded. Results: There were no differences between the groups in terms of age, sex, APACHE II scores, CRP, ventilation days. There were no significant differences between the groups in terms of gastrointestinal culture, septic complications or mortality. Conclusion: The administration of prebiotic solution in intensive care patients with severe sepsis had no effect on gastrointestinal permeability, gastric colonisation, the systemic inflammatory response and morbidity.
The Effects of Different Insufflation Pressures on Cerebral Oxygen Saturation in Patients Undergoing Laparoscopic Cholecystectomy
(Springer India, 2020) Inal, Mehmet Turan; Memis, Dilek; Sezer, Atakan; Turan, Nesrin
A pneumoperitoneum during laparoscopic procedures has deleterious effects on cerebral perfusion and oxygenation. Our aim was to assess the effects of different insufflation pressures on cerebral oxygen saturation (rSO(2)) using a noninvasive INVOS Cerebral Oximeter (Somanetics Corporation, USA) system. One hundred patients scheduled for laparoscopic cholecystectomy were included and divided into two groups: a 10 mmHg pneumoperitoneum group (group I) and a 14 mmHg pneumoperitoneum group (group II). The rSO(2)measurements were obtained preinsufflation, after insufflation, every 15 min after insufflation, and 10 min after desufflation. Hemodynamic variables and anesthesia and surgery times were recorded. Between the two groups, there were no statistically significant differences in terms of age, sex, weight, anesthesia times, or surgery times (p > 0.05). The hemodynamic variables were similar in the two groups (p > 0.05). The rSO(2)value changed over time, with a statistically significant between-group difference (p = 0.001). The preinsufflation rSO(2)value was 70.07 +/- 7.73 in group I and 72.21 +/- 6.58 in group II, with no significant between-group difference (p > 0.05). After insufflation, the rSO(2)value decreased to 69.60 +/- 7.74 in group I and 64.41 +/- 6.48 in group II, and the distinction was statistically significant (p < 0.001). A high-pressure pneumoperitoneum was associated with a greater decrease in rSO2 as compared to a low-pressure pneumoperitoneum. Thus, we suggest the use of a low-pressure pneumoperitoneum in patients with central nervous system pathologies.
The effects of different insufflation pressures on liver functions assessed with limon on patients undergoing laparoscopic cholecystectomy
(Oxford Univ Press, 2012) Eryylmaz, H. Barys; Memis, Dilek; Sezer, Atakan; Ina, Mehmet Turan
[Abstract Not Available]
The Effects of Different Insufflation Pressures on Liver Functions Assessed with LiMON on Patients Undergoing Laparoscopic Cholecystectomy
(Hindawi Ltd, 2012) Eryilmaz, H. Baris; Memis, Dilek; Sezer, Atakan; Inal, Andmehmet Turan
Purpose. Laparoscopic cholecystectomy has been accepted as an alternative to laparotomy, but there is still controversy regarding the effects of pneumoperitoneum on splanchnic and hepatic perfusion. We assessed the effects of different insufflation pressures on liver functions by using indocyanine green elimination tests (ICG-PDR). Methods. We analyzed 43 patients who were scheduled for laparoscopic cholecystectomy. The patients were randomly allocated to two groups. In Group I, the operation was performed using 10 mmHg pressure pneumoperitoneum. In Group II, 14 mmHg pressure pneumoperitoneum was used. The ICG-PDR measurements were made after induction (ICG-PDR 1) and after the end of the operation (ICG-PDR 2). Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin levels were all recorded preoperatively, 1 hour, and postoperative 24 hours after surgery. Results. The ICG-PDR 1 values for Groups I and II were as follows: 26.78 +/- 4.2% per min versus 26.01 +/- 2.4% per min (P > 0.05). ICG-PDR 2 values were found to be 25.63 +/- 2.1% per min in Group I versus 19.06 +/- 2.2% per min in Group II (P < 0.05). There was a statistically significant decrease between baseline and postoperative ICG-PDR values in Group II compared to Group I (P < 0.05). Statistically, there was an increase between baseline and postoperative 1st-hour serum AST and ALT level in Group II (P < 0.05) compared to Group I. No statistical differences were detected on postoperative 24st-hour serum AST and ALT levels and all the time bilirubin between groups (P > 0.05). Conclusion. In conclusion, the results show that 14 mmHg pressure pneumoperitoneum decreased the blood flow to the liver and increased postoperative 1st-hour serum AST and ALT levels. We think that 10 mmHg pressure pneumoperitoneum is superior to 14 mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy.
Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients
(Cma-Canadian Medical Assoc, 2011) Inal, Mehmet Turan; Memis, Dilek; Sezer, Y. Atakan; Atalay, Meltem; Karakoc, Abdullah; Sut, Necdet
Background: Intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with significant morbidity and mortality in critically ill patients. Our aim was to assess the effects of IAH on liver function using the noninvasive liver function monitoring system LiMON and to assess the prognostic value of IAP in critically ill patients. Methods: We conducted a retrospective analysis of critically ill patients who were treated in the intensive care unit (ICU). The IAP and indocyanine green plasma disappearance rate (ICG-PDR) measurements were made within 24 hours after admission to the ICU and repeated 12 hours later. Intra-abdominal pressure was measured via a Foley bladder catheter, and ICG elimination tests were conducted concurrently using the LiMON. Results: We included 30 critically ill patients (17 women and 13 men aged 28-89 yr) in our analysis. Statistical analysis showed that the baseline IAP values were significantly higher among nonsurvivors than survivors (19.38 [standard deviation; SD 2.08] v. 13.07 [SD 0.99]). The twelfth-hour IAP values were higher than baseline measurements among nonsurvivors (21.50 [SD 1.96]) and lower than baseline measurements among survivors (11.71 [SD 1.54]); the difference between groups was significant (p < 0.001). The baseline ICG-PDR values were significantly lower among nonsurvivors than survivors (10.86 [SD 3.35] v. 24.51 [SD 6.78]), and the twelfth-hour ICG-PDR values were decreased in all groups; the difference between groups was significant (p < 0.001). Conclusion: Our results suggest that measurement of ICG-PDR with the LiMON is a good predictor of the effects of IAP on liver function and, thus, can be recommended for the evaluation of critically ill patients.
The effects of levosimendan vs dobutamine added to dopamine on liver functions assessed with noninvasive liver function monitoring in patients with septic shock
(W B Saunders Co-Elsevier Inc, 2012) Memis, Dilek; Inal, Mehmet Turan; Sut, Necdet
Background: Septic shock is the leading causes of death in intensive care units. In addition to generous fluid administration, inotropic agents are commonly used to improve cardiac output. The effects of inotropic agents on regional blood flow remains unknown. Objective: The aim of this study was to assess the effects of levosimendan vs dobutamine added to dopamine on liver functions assessed using noninvasive liver function monitoring (LiMON) in patients with septic shock. Design: Prospective analysis. Measurements and results: We analyzed 30 patients with septic shock who were treated in an intensive care unit. Indocyanine green plasma disappearance rate (ICG-PDR) was conducted concurrently using the LiMON system. A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus. Results: Statistical analysis showed that the variation of hemodynamic variables was different between groups. In our results, the increase in systolic blood pressure, diastolic blood pressure, and mean arterial pressure was significantly higher in levosimendan group than in dobutamine group (P < .05). There was a decrease in before-and after-infusion ICG-PDR values in dobutamine group (20.38 +/- 4.83 vs 20.34 +/- 5.30), and no statistical difference was detected (P = .649). There was an increase in before-and after-infusion ICG-PDR values in levosimendan group (18.70 +/- 2.59 vs 21.65 +/- 3.20), and a statistical difference was detected (P = .001). There was statistical difference between groups (P = .000). Conclusion: These results suggest that levosimendan added to dopamine improves systemic hemodynamics and increases splanchnic perfusion assessed using the user-friendly noninvasive bedside system LiMON in patients with septic shock compared with dobutamine. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved.

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