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    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.
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    Modified 45-degree head-up tilt increases success rate of lumbar puncture in patients undergoing spinal anesthesia
    (Springer Japan Kk, 2014) Sahin, Sevtap Hekimoglu; Colak, Alkin; Arar, Cavidan; Yildirim, Ilker; Sut, Necdet; Turan, Alparslan
    Lumbar puncture (LP) is one of the most common procedures performed in medicine. The aim of this prospective study is to determine the success rate of LP in lateral decubitus with 45-degree head-up tilt position, and compare it with traditional positions like sitting and lateral decubitus. Three hundred and thirty patients between 25 and 85 years of age who had undergone abdominal, urologic, and lower limb extremities surgeries were enrolled and 300 patients were divided into three different groups. The LP was performed with a 25-G atraumatic needle, either in the standard sitting position (group S, n = 100), lateral decubitus, knee-chest position (group L, n = 100) or lateral decubitus, knee-chest position with a 45-degree head-up tilt (group M, n = 100). The free flow of clear cerebrospinal fluid (CSF) upon first attempt was considered to be evidence of a successful LP. Total LP success rate was significantly higher in group M (85 %) than in groups S and L (70 and 65 %, respectively) (p = 0.004). When the significance between the groups was evaluated according to age, the increase in the LP success rate was not significant for a parts per thousand currency sign65 and > 65 age groups. There were no differences among the three groups in terms of bloody CSF (p = 0.229) and the number of attempts before dural puncture (p = 0.052). The lateral decubitus in knee-chest position with a 45-degree head-up tilt may be the preferred position for spinal anesthesia in young and elderly patients, due to the high success rate.
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    The prognostic value of cerebral oxygen saturation measurement for assessing prognosis after cardiopulmonary resuscitation
    (Elsevier Science Inc, 2017) Inal, Mehmet Turan; Memis, Dilek; Yildirim, Ilker; Ugur, Hueyin; Erkaymaz, Aysegul; Turan, F. Nesrin
    Background: Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation. Objective: To assess the prognostic value of cerebral oxygen saturation measurement (rSO(2)) for assessing prognosis on patients after cardiopulmonary resuscitation. Design: Retrospective analysis. Measurements and results: We analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33-34 degrees C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO(2) measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO(2) measurements were made after the patient's temperature reached 36 degrees C. Results: In survivors, the baseline rSO(2) value was 67.5 (46-70) and the percent difference between baseline and rewarming rSO(2) value was 0.03 (0.014-0.435). In non-survivors, the baseline rSO(2) value was 30 (25-65) and the percent difference between baseline and rewarming rSO(2) value was 0.031 (-0.08 to -20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO(2). Statistically significant difference was detected between baseline and rewarming GCS groups (p = 0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO(2) to determine the prognosis. Conclusion: Despite higher values of rSO(2) on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO(2) values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO(2) may be a useful predictor for determining the prognosis after CPR. (C) 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.