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Giriş ve Amaç: kaudal anestezi çocuklarda alt batın cerrahilerinde postoperative analjezide kullanılan popüler bir tekniktir. Anestezisitler Kaudal bloğun sınırlamalarından ötürü alternatif rejyonel anestezi tekniklerini araştırmak zorunda kalmışlardır. Çalışmamızda; kaudal blok ve ultrason yardımlı TAP bloğun posoperatif analjezide etkinliğini ve güvenilirliğini karşılaştırmayı amaçladık.Gereç ve Yöntem: Çalışma ASA 1-II, 2-10 yaş aralığında alt batın cerrahisi operasyonu olan hastalarda yapıldı. grup C de (kaudal blok, n: 31), 0,3 mL.kg-1 ve grup T (TAP blok, n: 30), 0,5 mL.kg-1 0,25 % levobupivacaine ameliyat sonrası uygulandı.. Hastalar postoperatif 0., 1., 4., 6. saatlerde revize edilmiş yüzler skalası (FPS-R) kullanılarak ağrı skorları açısından değerlendirildi. Analjezik tüketimi, komplikasyonlar ve yan etkiler kaydedildi. istatistiksel analizlerde Student's t testi, ANOVA, Fisher exact testi kullanıldı.Bulgular: İki grup arasında demografik verilerde anlamlı bir fark yoktu. TAP bloğu için kullanılan lokal anestezik miktarı kaudal bloktan daha fazlaydı (T: 8,3 ± 4,3> C: 4,1 ± 0,9) (p, Introduction. Caudal anesthesia is a very popular postoperative analgesia technique for pediatric lower abdominal surgery. Because of the limitations of caudal block anesthesiologists need to search for alternative regional anesthesia techniques.This study aims to compare the effects and safety of Ultrasound-assisted TAP block and caudal block in postoperative analgesia.Methods. The study was conducted in ASA grade I-II, 2-10 years aged cases scheduled for lower abdominal surgery. At group C (caudal block , n: 31), 0,3 mL.kg-1 and at group T (TAP block, n: 30), 0,5 mL.kg-1 0,25 % levobupivacaine applied at the end of surgery. Patients were assessed for the quality of pain relief by using faces pain scale-revised (FPS-R) at 0., 1., 4., 6., hours of the postoperative period. Analgesic consumption, complications and adverse effects was recorded. Student’s t-test, ANOVA, Fisher exact test were used for statically analyses. Results. Between two group there were no significant differences at demographical data. The local anesthetic volume used for TAP block was more than caudal block (T:8,3±4,3 > C: 4,1±0,9) (p

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

Objectives: Endometrial receptivity plays the most important role for successful implantation. Increasing endometrial receptivity may improve infertility and increase Assisted Reproductive Technologies success. The aim of this study was to investigate the effect of exosome specific markers CD63 and CD9 which are promising molecules in the pathogenesis and treatment of many diseases on endometrial receptivity in women with unexplained infertility. Material and methods: This prospective study was conducted between November 2015 and March 2017. Proliferation and secretion periods of endometrial samples from fertile and infertile cases were collected. The paraffin-embedded tissue sections were stained with hematoxylin-eosin for the immunohistochemical analysis distributions of CD63 and CD9. Results: The results of this study demonstrated that the CD63 immunoreactivity was higher in both luminal and glandular epithelium of infertile patients when compared with fertile patients during the proliferative phase (p = 0.009, p = 0.008). In the infertile proliferation phase, endometrium CD9 immunoreactivity was rarely detected in both the luminal and glandular epithelium. In the secretion phase of endometrium, CD9 immunoreactivity was mild in fertile patients, the increased immunoreactivity of CD9 was observed in both luminal and glandular epithelium of infertile patients (p = 0.037, p = 0.037). Conclusions: Increased levels of CD63 in infertile proliferation phase endometrium should represent an unfavorable signaling. Moreover, the increased levels of CD9 in infertile secretion phase endometrium could be used as a biomarker to evaluate endometrial receptivity. These exosome-specific markers can be considered as potential molecular markers of infertility.

Objectives: To compare the time interval of the procedure, possible complications, post-operative pain levels, additional analgesics, and nurse satisfaction in ultrasonography-guided and standard caudal block applications. Methods: This retrospective study was conducted in Celal Bayar University Hospital, Manisa, Turkey, between January and December 2014, included 78 pediatric patients. Caudal block was applied to 2 different groups; one with ultrasound guide, and the other using the standard method. Results: The time interval of the procedure was significantly shorter in the standard application group compared with ultrasound-guided group ( p =0.020). Wong-Baker FACES Pain Rating Scale values obtained at the 90th minute was statistically lower in the standard application group compared with ultrasound-guided group ( p =0.035). No statistically significant difference was found on the other parameters between the 2 groups. The shorter time interval of the procedure at standard application group should not be considered as a distinctive mark by the pediatric anesthesiologists, because this time difference was as short as seconds. Conclusion: Ultrasound guidance for caudal block applications would neither increase nor decrease the success of the treatment. However, ultrasound guidance should be needed in cases where the detection of sacral anatomy is difficult, especially by palpations. Saudi Med J 2016; Vol. 37 (2): 147-150 doi: 10.15537/smj.2016.2.13501 How to cite this article: Erbuyun K, Acikgoz B, Ok G, Yilmaz O, Temeltas G, Tekin I, et al. The role of ultrasound guidance in pediatric caudal block . Saudi Med J 2016; 37: 147-50.

Pediatric regional anesthesia is widely used to relieve postoperative pain after abdominal surgery. Commonly used techniques of regional anesthesia include lumbar epidural and caudal block. However, the use of central neuraxial blockade has limitations. It is contraindicated in patients with clotting abnormalities, spinal dysraphism with tethered cord syndrome, meningomyelocele, and following spinal surgery with instrumentation. Ultrasound guided transversus abdominis plane block is a new method of regional anesthesia that can be used in settings where central neuraxial blockade is contraindicated. In this study, we present 5 pediatric cases in which major abdominal surgery was performed but central neuraxial blockade could not be carried out due to spinal abnormalities. © 2018, Saudi Arabian Armed Forces Hospital. All rights reserved.

Background/aim: Factors affecting neurological outcome and the usefulness of neuron-specific enolase (NSE), S-100B, glial fibrillary acidic protein (GFAP), and procalcitonin (PCT) in predicting neurological outcomes were assessed in patients who survived at least 24 h after cardiopulmonary resuscitation (CPR). Materials and methods: Thirty successfully resuscitated cardiac arrest patients were included in this prospective clinical study. The initial cardiac arrest rhythm, duration of CPR, return of spontaneous circulation time, administered doses of adrenaline, base excess, blood sugar, and hemodynamic parameters were recorded. Patients with Glasgow Outcome Scale (GOS) scores of 1 3 were defined as Group I and patients with GOS scores of 4 5 were defined as Group II. Serum NSE, GFAP, S-100B, and PCT levels were compared between the two groups shortly after CPR (hour 0) and at hours 12 and 24 of the postresuscitation period. Results: Serum S-100B was significantly higher (P = 0.009) in Group II immediately after CPR. Serum S-100B and NSE after CPR at hours 0, 12, and 24 were significantly lower in patients who survived to hospital discharge. Serum PCT at hours 12 and 24 and serum S-100B after CPR at 0, 12, and 24h reached 94.7% sensitivity. Serum NSE, GFAP, S-100B, and PCT specificities were lower than 50%. Conclusion: In predicting neurological outcomes, serum S-100B has high sensitivity and low specificity immediately after CPR.

Background/aim Factors affecting neurological outcome and the usefulness of neuron-specific enolase (NSE), S-100B, glial fibrillary acidic protein (GFAP), and procalcitonin (PCT) in predicting neurological outcomes were assessed in patients who survived at least 24 h after cardiopulmonary resuscitation (CPR). Materials and methods Thirty successfully resuscitated cardiac arrest patients were included in this prospective clinical study. The initial cardiac arrest rhythm, duration of CPR, return of spontaneous circulation time, administered doses of adrenaline, base excess, blood sugar, and hemodynamic parameters were recorded. Patients with Glasgow Outcome Scale (GOS) scores of 1-3 were defined as Group I and patients with GOS scores of 4-5 were defined as Group II. Serum NSE, GFAP, S-100B, and PCT levels were compared between the two groups shortly after CPR (hour 0) and at hours 12 and 24 of the postresuscitation period. Results Serum S-100B was significantly higher (P = 0.009) in Group II immediately after CPR. Serum S-100B and NSE after CPR at hours 0, 12, and 24 were significantly lower in patients who survived to hospital discharge. Serum PCT at hours 12 and 24 and serum S-100B after CPR at 0, 12, and 24 h reached 94.7% sensitivity. Serum NSE, GFAP, S-100B, and PCT specificities were lower than 50%. Conclusion In predicting neurological outcomes, serum S-100B has high sensitivity and low specificity immediately after CPR.

This study was designed to investigate the influence of saline injections as epidural top-up on the sensory block duration, quality and hemodynamic effects of unilateral spinal anesthesia. The cases from ASA I-Il containing of 18-65 age group were randomly separated into three groups. For the purpose of unilateral spinal anesthesia, 6 mg 0.5% ‘heavy’ bupivacaine and for the purpose of epidural top-up, 10 mL saline were applied to the each patients of the groups. The study protocol was designed as:Ist group: Coming after the epidural catheter installation, unilateral spinal anesthesia was applied (n=20).IInd group: At first, unilateral spinal anesthesia was applied and after one minute, epidural top-up was done via the pre-installed epidural catheter (n=20).IIIrd group: At first the epidural catheter was installed and epidural top-up was applied. After one minute, unilateral spinal anesthesia was fulfilled (n=2O). Starting from the pre-anesthesic period, the hemodynamic data and following the anesthesia, the sensorial and motor block levels were recorded and evaluated.As the outcome of the inter-groups comparison of heart rate and mean arterial pressure, a statistically note-worthy differance was not determined; statistically significant but clinically acceptable hemodynamic changes were observed in intra-group evaluations, when the data was compared with control levels. The sensorial block levels were significantly higher in group II and significantly lower in group III.The application of 10 mL saline via epidural catheter 1 minute after the unilateral spinal anesthesia and remaining the patient leaning on the side of the extremity to be operated for 15 minutes improves the sensory block level of unilateral spinal anesthesia. It is determined that, for the lower extremity surgical operations with 1-1.5 hour estimated period, this method alone can be a worthwhile alternative.

Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy (PEG) technique has been used to create a reliable route for long term enteral feeding in cri0,0tically ill patients. Our goals were to determine the complications of PEG in ICU patients.We evaluated the data of 13 intensive care unit patients undergoing bedside PEG for gastric tube placement using the “pull” technique. Percutaneous endoscopic gastrostomy was completed and gastric tube was placed successfully in all patients. Tubes remained in stomach from 13 to 831 days (mean 146 days). Six patients died because of the reasons unrelated to the PEG tube and seven patients were discharged from the hospital while being fed via the PEG. Nutritional intolerance (in 4 patients) and bleeding (in 3 patients) were observed and could be eradicated by appropriate maintenance. Bleeding was the main PEG complication observed in critically ill patients.

AMAÇ: Postpartum dönem, ebeveynler ve bebek için aile olma konusunda karmaşık bir geçiş sürecini beraberinde getiren fiziksel, sosyal ve duygusal değişimlerin meydana geldiği zorlu bir dönemdir. Çalışmamızda bu dönemi etkileyen faktörler arasında olan sezaryen olgularına uygulanan anestezi yönteminin günlük yaşam etkinliklerine dönüşe etkisini araştırmayı planladık YÖNTEMLER: Çalışmaya, Celal Bayar Üniversitesi Tıp Fakültesi Hastanesinde elektif şartlarda sezaryen olan 206 olgu dahil edildi. Demografik veriler ve uygulanan anestezi yöntemi kayıt edildikten sonra çalışmaya katılan olgulara postoperatif 24.saat yüz yüze ve 5. gün telefon görüşmesi altında EQ 5D genel sağlık ölçeği(GSÖ) ve Katz Günlük Yaşam Etkinlikleri (Katz GYE) Ölçeği soruları yöneltildi. BULGULAR: Olguların % 35.2 i (n: 71) genel anestezi, % 19.8 i (n: 40) epidural anestezi, % 45 i (n: 91) spinal anestezi altında ameliyat edildi. EQ-5D GSÖ ve uygulanan 3 anestezi yöntemi birlikte incelendiğinde 24.saatte epidural anestezi grubunun skorları daha iyi saptanırken, genel anestezi grubunun skoru en düşük olarak saptandı (p: 0.007). Katz GYE anketi 24. saat sonuçları, uygulanan anestezi yöntemleri ile değerlendirildiğinde, epidural anestezi uygulananlarda günlük yaşam etkinliklerine dönüşte bağımsızlık oranı diğer anestezi gruplardakilere göre daha yüksek bulundu (p

Postpartum period is physically, socially and emotionally a difficult time for the parents and the baby to become a family. We tried to investigate how the anaesthesia method affects patients who underwent cesarean delivery, as a factor which also affects this period.Two hundred and six parturients, who underwent elective cesarean delivery in Celal Bayar University Hafsa Sultan Hospital were recruited for our study. After demographic data and anaesthesia methods were noted, an EQ-5D health survey and Katz ADL scale were evaluated face to face 24 hours postoperatively, and by telephone on the 5th postoperative day.The percentage of patients who had general anaesthesia was 35.2% (n=71), while 19.8% (n=40) had epidural anaesthesia and 45% (n=91) had spinal anaesthesia. Among -these three methods, the EQ-5D health survey revealed that the outcome at postoperative 24 hours was best in epidural anaesthesia and that general anaesthesia outcome was the worst (p=0.007). The Katz ADL scale at postoperative 24. hours showed that epidural anaesthesia was better than the other methods for regaining daily life activities (p0.05).Our study showed that epidural anaesthesia had the most effective role among the methods in regaining daily life activities after elective cesarean delivery, which was demonstrated using the EQ-5D health survey and Katz ADL scale.

Healthcare workers’ cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P

AMAÇ Bu prospektif kontrollü deneysel çalışma, levosimendanın erken dönem sepsiste transforming growth factor (TGF)-β3 ve Smad1, Smad2 ve Smad3 oluşumuna etkilerini araştırmak amacıyla planlandı. GEREÇ VE YÖNTEM Yirmi dört sıçan rasgele dört gruba ayrıldı: 1) sham kontrol grubu 2) dobutamin grubu - abdominal hipertansiyon, çekal ligasyon ve delme (ÇLD) tekniği ile peritonit modeli prensibiyle sepsis oluşturuldu, sonra sıçanlar 10 µg.kg-1 dk-1 intravenöz (IV) dobutamin infüzyonu ile tedavi edildi, 3) levosimendan grubu - 2. grupta olduğu gibi sepsis modeli gerçekleştirildi sonra sıçanlar levosimendan IV bolus 200 µg.kg-1 takiben, 200 µg.kg.-1 dk-1 IV infüzyonu ile tedavi edildi, 4) kontrol grubundakilere tedavi yapılmadı. Tüm sıçanlar ÇLD?den 8 saat sonra öldürüldü. Aort doku örnekleri immünohistokimyasal olarak boyandı. BULGULAR ÇLD hem kontrol, hem de dobutamin gruplarında ılımlı IL-1 boyanmasına neden oldu. Tumor necrosis factor (TNF)-α immünreaktivitesi sham ve kontrol grubunda ılımlıydı. Sham, kontrol ve dobutamin gruplarında TGF-β3 ılımlı derecede yüksek bulunurken, bu parametre levosmendan grubunda orta derecede yüksek saptandı. Smad1, Smad2 ve Smad3 levosmendan grubunda orta derecede yükselmiş olarak saptandı. SONUÇ Levosimendanın hemodinami ve global oksijen taşınmasına sağladığı olumlu etkiler, deneysel ve klinik çalışmalarda bildirilmiştir. Levosimendanın C++ iyon duyarlılığı üzerine etkileri yanı sıra, TGF-β3, Smad1, Smad2 ve Smad3 oluşumunu etkileyerek enflamasyonda sitokin salınımına da etkileri olabilir. BACKGROUND This prospective, controlled experimental study was planned to investigate the effects of levosimendan on transforming growth factor (TGF)-β3 and Smad1, Smad2 and Smad3 expression in the early stages of sepsis. METHODS Twenty-four rats were randomized into four groups: 1) sham-operated controls, 2) dobutamine group - subjected to abdominal hypertension and peritonitis-induced sepsis using cecal ligation and puncture (CLP), then treated with 10 µg.kg-1min-1 intravenous (IV) dobutamine infusion, 3) levosimendan group - as in 2, then treated with levosimendan IV bolus 200 µg.kg-1 followed by 200 µg.kg.-1 min-1 IV infusion, and 4) a control group as in 2, with no treatment. All rats were killed 8 hours after CLP. Aorta tissue samples were analyzed by immunohistochemical staining. RESULTS CLP caused mild interleukin (IL)-1 immunostaining in both control and dobutamine groups. Immunoreactivity of tumor necrosis factor (TNF)-α was mild in both sham and control groups. TGF-β3 immunostaining was mildly increased in groups sham, control and dobutamine, whereas it was found moderate in group levosimendan. Smad1, Smad2 and Smad3 were found moderately increased only in group levosimendan. CONCLUSION Beneficial effects of levosimendan on hemodynamics and global oxygen transport were reported in experimental and clinical trials. Besides its potency on C++ ion sensitivity, it should influence inflammatory cytokine production by diminishing TGF-β3 and Smad1, Smad2 and Smad3 expression.

Bu çalışmada, sezaryen operasyonu uygulanacak gebelerde intratekal yolla uygulanan ropivakain ile ropivakain + neostigmin kombinasyonlarının anestezik etkilerinin karşılaştırılması amaçlanmıştır. ASA I-II, 18-42 yaş arasındaki 40 olgu rasgele iki gruba ayrılarak çalışmaya dahil edildi. Grup I’e spinal anestezi için 15 mg % 0.75 ropivakain (2 ml) + 0.5 ml % 20 dekstroz uygulandı. Grup II’ye spinal anestezi için 15 mg % 0.75 ropivakain (2 ml) + 0.5 ml % 20 dekstroz çözeltisinde hazırlanmış 25 µgr neostigmin çözeltisi uygulandı. Spinal anestezi uygulandıktan sonra hastalar supin pozisyonda baş 20-30° yukarıda olacak şekilde yatırıldı. Spinal anestezi uygulanmasının beş dakika öncesinden başlanarak KAH, OAB ve SpO2 değerleri, spinal anestezinin uygulanmasıyla da 5’er dakika aralarla DB ve MB seviyeleri değerlendirilerek tüm operasyon boyunca kaydedildi. Postop dönemde 1., 2, ve 4. saatlerde KAH, OAB, SpO2, DB ve MB seviyeleri ile VAS skorları izlenerek kaydedildi. VAS >4 olan hastalara analjezik uygulanarak, bu ilk analjezik gereksinimine kadar geçen süreler ve toplam analjezik tüketimi kaydedildi. Her iki grupta ilk analjezi ihtiyacına kadar geçen süreler arasında istatistiksel olarak anlamlı fark bulunmadı. KAH, OAB ve değerleri iki grup arasında benzerdi. DB ve MB seviyeleri ile VAS skorları arasında istatistiksel olarak anlamlı fark bulunamadı. Sonuç olarak, intratekal 25 µgr neostigminin, yan etkiye yol açmadan, ilk analjezik gereksinimine kadar geçen süreyi, istatistiksel olarak anlamlı olmasa da uzattığı gözlendi. Efficacy of Ropivacaine and Ropivacaine+Neostigmine Combination for Elective Cesarean Sectio The objective of this study is to compare the efficacy of intrathecal ropivacaine and the combination of ropivacaine with neostigmine for elective cesarean sectio. Forty ASA grade I-II parturients were scheduled for elective cesarean delivery under spinal anesthesia. The patients were randomly assigned into two groups. Grup 1 received 15 mg of 0.75 % hyperbaric ropivacaine. Group 2 received 15 mg of % 0.75 hyperbaric ropivacaine combined with 25 µgr neostigmine. Hyperbaric solutions were made with 2 ml of 0.75 % ropivacaine and 0.5 ml of 20 % dextrose. After injection of the spinal medication patients were turned head up 20-30° supine. Baseline mean arterial blood pressure, heart rate, pulse oximetry were recorded and every 5 min during the surgery the same parameters also sensory block level, motor block degree were recorded. Sensory block, motor block and VAS scores were recorded postoperatively at first, second and forth hour. Time until first analgesic requirement and total analgesic consumption in the first 24 hours were recorded. Homodynamic changes, sensory block level, motor block degree, VAS scores, time until first analgesic requirement, postoperative total analgesic consumption were similar among two groups. No statistically note-worthy difference was determined. In conclusion, the time until first analgesic requirement is increased by 25 µgr neostigmine without any adverse effect although there wasn’t any significant difference.

Introduction Surgery operations of children causes serious anxiety for parents. Objectives and Aims The study was designed to determine the factors increasing the severity of anxiety existing in the parents whose children will have an operation and what can be done to decrease it. Method 200 parents were asked to complete the social demographic data form, Beck Anxiety Inventory(BAI), State-Trait Anxiety Inventory(STAI) before the surgery. Results Mothers had higher scores of BAI and Trait Anxiety. The BAI score of two year-old and older children's parents had greater value than the one year-old children's parents(p=0.020). The State Anxiety score of girls' family was found greater (p=0.049). The State Anxiety score of the parents who are unlettered/graduated from primary school was greater than those who graduated from high school/college(p=0.026). The BAI scores of the parents with low occupational level/unemployed and housewives both were greater than those of the parents with average/high occupational levels(p=0.029). The BAI score of parents with large families was lower than the parents with nuclear/fragmented families(p=0.043). The BAI score of parents whose families hadn't have surgery before had greater values. The Trait Anxiety score of parents whose children had a, b,c types of surgery operations was smaller than d, e types(p=0.036). Conclusion It was found that the mothers and parents who have daughters, with low educational levels and low socioeconomic status have continuous anxiety. Therefore, parents need to be informed more about children's diseases, the type of the surgery operation and the technique of anesthesia in pre/postoperative term.

Perkutan Endoskopik Gastrostomi (PEG) tekniği ilk tanımlandığı 1980’lerden buyana, kritik olgularda uzun süreli enteral beslemede uygun bir erişim yolu olarak kullanılmıştır. Bu çalışmada Anestezi Yoğun Bakım Ünitemizde izlenen hastalarda saptadığımız PEG komplikasyonlarının sunulması amaçlandı. Yatak başında “pull” tekniği ile PEG kanülü yerleştirilen 13 olgunun kayıtları incelendi. Tüm olgulara PEG tekniği sorunsuz uygulandı ve kanül başarı ile yerleştirildi. Gastrostomi tüplerinden beslenme süresi 13 ila 831 gün (ortalama 146 gün) olarak saptandı. 6 olgu PEG ile ilişkisi olmayan nedenlerden kaybedildi; 7 olgu PEG ile beslenmeye devam ederek taburcu edildi.4 olguda beslenme intoleransı ve bunların 3’ünde kanama gelişmesi dışında herhangi bir komplikasyonla karşılaşılmadı; bu sorunlar da uygun yaklaşımlarla tedavi edilebildi. Yoğun bakım ünitemizde karşılaştığımız en önemli PEG komplikasyonu kanamaydı. Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy (PEG) technique has been used to create a reliable route for long term enteral feeding in cri0,0tically ill patients. Our goals were to determine the complications of PEG in ICU patients. We evaluated the data of 13 intensive care unit patients undergoing bedside PEG for gastric tube placement using the “pull” technique. Percutaneous endoscopic gastrostomy was completed and gastric tube was placed successfully in all patients. Tubes remained in stomach from 13 to 831 days (mean 146 days). Six patients died because of the reasons unrelated to the PEG tube and seven patients were discharged from the hospital while being fed via the PEG. Nutritional intolerance (in 4 patients) and bleeding (in 3 patients) were observed and could be eradicated by appropriate maintenance. Bleeding was the main PEG complication observed in critically ill patients.

Çalışmamızda, diyazepam premedikasyonunun, tiyopental ile yapılan anestezi indüksiyonu sırasında oluşan havayolu değişikliklerine etkisi araştırıldı. Elektif cerrahi planlanan, ASA I-II. grubu, 20-50 yaş arası 40 olgu, 2 gruba ayrıldı. I. Gruba, operasyondan l saat önce 10 mg diyazem peroral verilirken, II. Gruba premedikasyon yapılmadı. Nabız, TA, EKG, SpO2, PETC02 monitörize edilerek, baş nötral pozisyona alındı. Olgular maske ile ventile edilirken ultrasonografi probu çene altına yerleştirilerek dil hareketlerinin ultrasonografik görüntüsü alındı. Anestezi indüksiyonunda kirpik refleksi kaybolana kadar sodyum tiyopental iv verildi. Dilin hareketleri indüksiyon öncesinden, kirpik refleksi ve bilincin kaybolmasından l dakika sonrasına kadar görüntülendi. Maske ile zor ventilasyon varlığı (ZMV) kaydedildi. Ultrasonografi probunun konulduğu nokta ile, dil arkının ön ve arka noktası arasındaki mesafeler ölçüldü. Ölçümler, indüksiyon öncesi ve sonrasında yapıldı ve farklar kaydedildi. Grupların demografik verileri ve ASA sınıflaması benzerdi (p>0.05). Premedikasyonlu ve premedikasy onsuz olgularda dilin herhangi bir yöne belirgin hareketi gözlenmedi (p>0.05). Tüm olguların % 30'unda ZMV gözlendi. Premedike olgularda ZMV oranının değişmediği, ancak apne oranının arttığı bulundu. Sonuç olarak ZMV'nün primer nedeninin dil hareketleri olmadığı kanısına varıldı. ZMV nün sadece premedikasyon ve indüksiyon için verilen anestezik maddelerle ilişkilendirilemeyeceği, 10 mg oral diyazepam premedikasyonunun, indüksiyonda kullanılan tiyopentalin santral apne etkisini potansiyelize ettiği düşünüldü. We aimed to determine diazepam premedication effect on airway changes during anesthesia induction with thiopental. 40 patients (ASA I-II, aged 20-50 years) who were planned to undergo elective operations were divided into 2 groups. 10 mg diazepam orally öne hour before operation, was given to Group I premedication was not given to Group H. We monitored pulse, TA, ECG, SpO2, PETCO2 and kept head in neutral position. We recorded ultrasonographic views oftongue movements by ultrasound probe located below the chin while the patients were ventilating by mask. For anesthesia induction Na pentothal was given iv until lash reflex diminished. Tongue movements were monitored before induction until one minute after lash reflex and consciousness were lost. Difflculty in mask ventilation was recorded. The distance between ultrasound probe and back-front points of tongue arc was measured and differences were recorded. The demografic data and ASA classification of groups were similar (p>0.05). Aparticular movement oftongue in any direction was not observed in either group (p>0.05). Difficult ventilation with mask was observed in 30% of ali patients. in patients with premedication apnea rate was found to be high. We concluded that difficult ventilation mthface mask was not result oftongue movement. Difficult ventilation with mask is not related with premedication or anesthetics given for induction alone; diazepam premedication is thought to potantialize central apnea effect of thiopenthal used for induction.

Çalışmamızda, pediatrik hastalarda, intranazal ketamin ve midazolam premedikasyonunun, etkinliği ve güvenilirliği karşılaştırıldı. Etik kurul onayından sonra, 2-7 yaş arasında ASA I, 40 olgu 2 gruba ayrıldı. Operasyondan 30 dk. önce Grup K’ya (ketamin grup) 5 mg kg-1 ketamin, Grup M’ye (midazolam grup) 0.25 mg kg-1 midazolam intranazal uygulandı. Olguların periferik O2 saturasyonu (SpO2), sistolik arter basıncı (SAB), diastolik arter basıncı (DAB), kalp atım hızı (KAH) ve solunum sayısı 0., 10., 20. ve 30. dakikada kaydedildi. Olguların sedasyon düzeyleri Ramsey sedasyon skalasına göre değerlendirildi. Aileden ayrılma 3 basamaklı skala (0:Ajite, 1:Sakin 2:Uyuyor), iv kanül yerleştirme 3 basamaklı skala (1:Ajite, 2:Elini çekiyor, 3:Tepki yok) ve operasyon sonrası derlenme skorları Aldrete skorlaması ile değerlendirildi ve yan etkiler kaydedildi. Demografik veriler, SpO2 ve solunum sayısı açısından gruplar arasında fark bulunmadı. Her iki grupta da bazal değere göre KAH, SAB, DAB’ında düşme görüldü. Ancak, Grup M’de sistolik arter basıncındaki düşme Grup K’dan daha belirgindi (p0.05). Aileden ayrılma skorları her iki grupta farklı bulunmadı. Aldrete skorları, Grup K’da daha yüksek bulunmasına karşın, istatistiksel olarak anlamlı fark saptanmadı (p=0.17). Grup K’da 4 olguda diplopi ve nistagmus izlendi. Bulgularımızda izlenen midazolam ile daha derin sedasyon ve ketamin ile daha hızlı derlenmenin premedikasyonda, ajan seçiminde yönlendirici olabileceği kanısına varıldı. After the approval of ethics' committee, 40 ASA I patients, aged between 2-7 years were divided into two groups. 30 min before operation, in group K (ketamine group), ketamine, 5 mg kg-1 and in group M (midazolam group), midazolam, 0.25 mg kg-1 were administered intranasally. Peripheral O2 saturation (SpO2), systolic arterial blood pressure (SAB), diastolic arterial blood pressure (DAB), heart rate (HR) and respiration rate were recorded at 0, 10, 20, and 30th minutes. Sedation levels of patients were evaluated according to the Ramsey Sedation Scale. Separation from the family were evaluated according to a three level scale; (0: Agitate 1: Calm, 2: Sleeping), iv cannulation condition were evaluated according to a three level scale (1:Agitate 2:Pulling his hand away 3:No reaction). Postoperative Aldrete recovery scores and adverse effects were recorded. Demographic data, SpO2 and respiratory rate were similar in both groups. In both groups, there was a significant decrease in SAB, DAB and HR values according to the baseline values (p