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Öğe Anesthesia and postoperative complications in sleeve gastrectomy operations performed in morbid obesity surgery(KUWAIT MEDICAL ASSOC, 2021) Gencer, Muzaffer; Sipahi, MesutObjectives: Sleeve gastrectomy is one of the most popular bariatric procedures today. Following laparoscopic interventions, common complications such as bleeding, organ damage, respiratory problems and emboli development are observed. The objective of this study was to evaluate our experiences with anesthesia and postoperative complications in sleeve gastrectomy operations performed in morbid obesity surgery. Design: Prospective study Setting: Operation room Subjects: Sixty adult patients who provided informed consent and who underwent laparoscopic sleeve gastrectomy from November 2015 to January 2019 (N=60). Intervention: Data collection, sleeve gastrectomy operation Main outcome measures: Postoperative complications were evaluated under headings: bleeding, respiratory problems, prolonged mechanical ventilation, prolonged hospital stay, emboli development and mortality. Results: None of the patients had mortality. Mean age was 36.2 (range: 18-59) years. Of the 60 morbid obese patients, 86.6% were female. Mean preoperative body mass index was 48.7 (range: 37-60) kg/m(2). The integrity of the anastomosis was controlled with a 36 French orogastric tube. The mean operating time was 43 minutes (range: 34-72) Two patients (3.3%) were re-intubated due to hypercarbia. Only two patients had bleeding on the postoperative 1st day. Mean length of hospital stay was 4.8 days. Conclusions: We believe there are fewer risks in the laparoscopic sleeve gastrectemy technique if there is careful preoperative patient preparation and evaluation with a multidisciplinary approach, appropriate perioperative anesthesia management, successful coordination with the surgical team and postoperative care.Öğe Case report: Complicated urinary tract infection with trichosporon asahii(NOBEL ILAC, 2022) Taşçıoğlu, Didem Akal; Yetkin, Gülay; Gencer, Muzaffer; Önalan, AyşenurTrichosphoron spp. are members of Basidiomycetous group organism (Basidiomycota, Hymenomycetes, Trichosporonales) thats widely distributed in nature. In humans although they are accepted as a member of gastrointestinal flora, they can be cultured infrequently as an infection agent in immunosupressive and patient with invasive intervention. The most common isolated type from invasive infections are Trichosphoron ashaii. Invasive trihosphoronosis is documanted mostly in patients with malignancies and medical conditions associated with immunosupressions and included usually as case reports in literature. In our case 64 year old male patient admitted in emergency with loss of consciousness and tight sided contraction. Five year ago he has history of cerebrovascular accident attack with ischemic episode and left sided hemiparesis. Patient has started to given anticoagulant therapy enoxaparin 0.6 cc 2x1 sc daily. Patient was followed for two months in intensive care unit. He has given the treatment protocol for lower respiratory tract infections with betalactam antibiotics combined with quinolone several times. During follow-up yeast was isolated from consecutive urine cultures (60.000-80.000 cfu/ml). It was identified as Trichosporon asahii using VITEK 2. Since the resistance limit values not yet confirmed for Trichosporon spp. the tratment is changed to lipozomal amphotericin B iv (3mg/kg) and flukanazol iv (400 mg/day). During follow-up treatment 64th day of hospitalization patient died because of cardiac reasons. Infections with Trichosporon asahii the mortality is high in the immunocompromised host. Therefore Trichosporon infections has to be diagnosed correctly as early as possible in clinical and preclinical perspective.Öğe Changes in various hormone levels in The rabbit traumatic facial nerve injury model(Deomed Publ, Istanbul, 2018) Kapusuz Gencer, Zeliha; Özkiriş, Mahmut; Gencer, Muzaffer; Göçmen, Ayşe Yeşim; Dağlıoğlu, Yusuf KenanObjectives: We aimed to look into potential associations between specific biomarkers and trauma to Cranial Nerve VII (CNVII) in a rabbit model, focusing on whether endocrine studies have potential as biomarkers in this context. Methods: 30 adult New Zealand rabbits with intact facial muscles were used for the research. Each animal underwent identical surgery by the same surgeon. The facial nerve divisions were exposed by incising below the level of the mandible. After dissection of the skin and subcutaneous layers, the buccal division of CNVII was located with the nerve stimulator and microscopic dissection and a section of nerve 10mm long was excised in each case from the buccal branch of CNVII. Blood samples were drawn 8 weeks and 12 weeks after nerve injury had been surgically induced. The samples from day 1, week 4 and week 8 were tested for the following levels: Testosterone, oestrogen, progesterone, free T3 and T4, Cancer antigen 19-9 (Ca19-9), folate, TPSA, FPSA, FSH, LH, CA15.3, CAE, AFP and prolactin. Results: The levels of free T3 and T4 as well as testosterone, were down at 4th week, but at 8 weeks each had increased. Ca19-9 levels were also above the baseline. At 4 weeks, whilst oestrogen had markedly risen, progesterone had fallen. The statistical significance of the change in levels of free T3 and T4, testosterone, oestrogen, progesterone and FPSA was evaluated. For the group of animals with induced paralysis, the association between the lesion and testosterone, oestrogen, progesterone, free T3 and T4, Ca19-9, and folate levels were strong and at the level of statistical significance. Conclusion: There were statistically significant alterations in the serum levels of free T3 and T4, testosterone, oestrogen, progesterone and FPSA at the 4 and 8 week intervals post surgically-induced CNVII injury. It is likely that rabbit pathophysiology resembles human pathophysiology in nervous injury, hence these six biomarkers may be of value in managing trauma or idiopathic degeneration of CNVII in humans. The authors hope this study will pave the way for future research in this area.Öğe Comparison of sedoanalgesia versus general anesthesia in surgical resection of carotid body tumors: a retrospective cohort study(JOSAM, 2021) Kalko, Yusuf; Gencer, Muzaffer; Çuğlan, Bilal; Koçyiğit, AliBackground/Aim: Carotid body tumors (CBTs) are very rare. There is no uniform agreement on the method of anesthesia according to the Shamblin classification. The aim of this study was to report and compare outcomes and complications of different anesthesia methods according to the Shamblin classification in patients operated for CBTs. Methods: The data of 52 patients (40 males, 12 females) diagnosed with CBT Shamblin Type 1 or Type 2 and surgically treated were enrolled. General anesthesia (Group G) and sedoanalgesia (Group S) were administered in 35 and 17 patients, respectively. We retrospectively compared the surgical outcomes and complications between the groups to evaluate which anesthetic approach was more appropriate for early recognition of complications, hemodynamic stability, and surgical satisfaction in CBT surgeries. Results Group S patients were more stable hemodynamically. Hypertension, tachycardia, hypotension were significantly more frequent in Group G (P<0.001). Intraoperative blood loss was significantly less in the Group S (P=0.024). Both patient and surgeon satisfaction scores were significantly higher in Group S (P=0.071). In Group G, transient ischemic attack developed in 1 patient, postoperative dysphagia developed in 4 patients due to possible nerve injury during resection. Deviation and ptosis of the tongue due to facial nerve damage developed in 3 patients in Group G and in 2 patients in Group S (P=0.028). Conclusions: Sedoanalgesia may be more helpful for patients compared to general anesthesia in tumor surgery of patients with CBT classified as Shamblin Type 1 and 2.Öğe Prevalence of human pseudocholinesterase (butyrylcholinesterase) deficiency in central Anatolian people: a cross-sectional study(DergiPark, 2020) Gencer, Muzaffer; Göçmen, Ayşe YeşimAim: Human pseudocholinesterase (PChE) is an enzyme responsible for hydrolysis of the muscle relaxant drugs like succinylcholine and mivacurium. PChE deficiency, which may lead to prolonged apnea, may occur due to hereditary or acquired causes. In our study, we aimed to investigate the prevalence of human pseudocholinesterase (PChE) enzyme deficiency around the central Anatolia region and present our results in light of the literature. Methods: This cross-sectional study included 936 patients (age 18-70 years) who underwent any elective surgery under general anesthesia between August 2015 and September 2019. Human PChE level, plasma PChE activity, the human PChE activity/albumin, serum liver and kidney function tests were analyzed from blood samples. Human PChE enzyme deficiency and possible association of the PChE deficiency with other values was also investigated. The normal value of PChE was considered to range from 4650 U/L to 10,440 U/L. Results: PChE activity was decreased in 19 (1.9%) of the 936 patients (442 males and 494 females). There was no statistically significant difference between the PChE levels in terms of gender (P=0.236). The mean human PChE activity of all patients was 7.490 (0.980). The PChE activity of 22 (2.35%) and 58 patients (6.4%) were below 5.000 U/ml and 6.000 U/, respectively. A statistically significant difference was found between serum urea, creatinine and human PChE levels (P=0.034, P=0.236, respectively). However, PChE deficiency had no correlation with liver function tests such as AST and ALT (P=0.432, P=0.022, respectively). Conclusion: PChE deficiency can be observed in preoperatively evaluated patients and may cause serious life-threatening conditions, including respiratory failure and prolonged apnea.Öğe The relationship between the level of ?-opioid receptor (?ORs) and postoperative analgesic use in patients undergoing septoplasty: a prospective randomized controlled trial(NLM (Medline), 2020) Gencer, Muzaffer; Gocmen, Ayse YesimBACKGROUND: In this study, the ?-Opioid receptor activity was assessed pre-operatively for its association with postoperative pain level and second analgesic requirement in patients undergoing septoplasty. METHODS: In our prospective study, 120 adult patients underwent septoplasty from June 2015 to January 2019 were randomly divided into 2 pre-operative groups. The first group (n?=?60) was patients given tramadol (1-2?mg/kg) for post-operative analgesia, and the second group (control group) (n?=?60) was initially prescribed only fentanyl (1??g/ kg-i.v.) in the induction. Acetaminophen with codeine analgesic 325/30?mg (p.o.) was used as an rescue painkiller in the post-operative period. The ?-Opioid receptor activity was investigated in pre-operative blood samples and compared to post-operative pain level and time required for second round of analgesic administration. The visual analogue score (VAS) was used to evaluate the post-operative pain degree (0 no pain; 10 worst pain). The patients' post-operative VAS scores were evaluated upon arrival to recovery room, and at the 1st, 3rd, 7th, 10th, and 24th hour post-operative period. RESULTS: Demographic data and peri-operative variables were similar in both study group (p?Öğe A study comparing the effect of premedication with intravenous midazolam or dexmedetomidine on ketamine-fentanyl sedoanalgesia in burn patients: a randomized clinical trial(Elsevier Ltd, 2021) Gencer, Muzaffer; Sezen, Ozlem K.Introduction: Dressing changes and wound care-debridement procedures often cause fear and anxiety in burn patients, as these processes are quite painful. In order to determine the best method for alleviating pain during these procedures, the current study compared the efficacy and safety of intravenous dexmedetomidine and midazolam for premedication prior to these painful burn care procedures. Methods: This comparative and randomized study included patients who had a burn size of 1563%, were aged 1870 years, were diagnosed with the American Society of Anesthesiologists physical status (ASA I–II), and who underwent painful burn care procedures. Patients were intravenously administered either 1 mcg/kg dexmedetomidine (Group 1) or 0.03 mg/kg midazolam (Group 2) prior to the burn care procedure. Recorded at predetermined time points for each patient were heart rhythm (HR), mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), standard bispectral index (BIS), and Ramsay Sedation Scale (RSS). Results: In the dexmedetomidine group, HR and MAP measurements of patients ??at the 3rd, 5th, and 10th mins during sedation were significantly lower than the baseline values (p < 0.05). A significant decrease in SpO2 was observed in both groups at the 10th min during sedation, but the decline was higher in the midazolam group (p < 0.05). BIS measurements of the patients in both groups were significantly lower at 10 min. during sedation and at 15th and 60th mins during the procedure (p < 0.05). However, there was no significant difference between the group (p > 0.05). The RSS scales of both groups in during the sedation were higher in the 3rd, 5th and 10th mins than the baseline values (p < 0.05), but there was no significant difference between the groups (p > 0.05). The RSS scales of groups in during the burn procedure were significantly higher at 15 th min than the 0 th values, while the RSS scales of both groups were significantly lower in the 45th and 60th mins (p < 0.05). Conclusion: Results of this study indicate that dexmedetomidine causes hemodynamic alterations while midazolam causes respiratory depression. However, these effects are not severe, and we conclude that both agents are safe and effective to ensure sedation prior to painful burn-care procedures.Öğe Ultrasonografi rehberliğinde interskalen brakial pleksus blok uygulamasının solunum fonksiyonları ve arteriyel kan gazı üzerine etkisi(2020) Gencer, MuzafferAmaç: Çalışmamızda ultrason rehberliğinde interskalen brakial pleksus blok uygulamasının solunum fonksiyonları ve arteriyel kan gazı analizi üzerine etkisini araştırmayı amaçladık. Gereç ve Yöntem: Çalışma, omuz bölgesi ve üst kol cerrahisi planlanan, ASA I-II, cerrahi süresi 2 saati geçmeyen, pulmoner disfonksiyonu olmayan, toplam 64 hasta ile yapıldı. Cerrahi sırasında anestezi sağlamak amaçlı USG-rehberliğinde interskalen brakial pleksus blok işlemi öncesi baseline (T0) ve blok sonrası 20. dk’ da (T20) kalp hızı, non-invaziv sistolik, diyastolik ve ortalama arter basıncı ölçülerek kaydedildi. Spirometri ve arteriyel kan gazı analizi yapılarak interskalen brakial pleksus blok uygulamasının solunum fonksiyonlarına ve arteriyel kan gazı üzerine etkisi değerlendirildi. Ayrıca blok uygulaması ile ilgili veriler kaydedildi. Bulgular: Blok sonrası 20.dk’ da kalp hızında daha belirgin olmak üzere (p =0,003), sistolik (p =0,375), diyastolik (p =0,608) ve ortalama arteriyel basınçta (p =0,496) baseline (T0) değerlere göre düşme gözlendi. Blok işlemi sonrası 20.dk’ da yapılan ikinci (T20) spirometrik ölçümde, baseline (T0) ile karşılaştırıldığında, vital kapasite (VC) (4,86-3,68, p <0,001), zorlu vital kapasite (FVC), zorlu ekspiratuar volüm 1.sn (FEV1) (4,24-3,40, p <0,018), Sniff PmaxPeak (6,18-5,06) (p <0,001) ve ort. PaO2 (86,40-79,24, p <0,024)’ de önemli oranda azalma gözlendi. Bununla birlikte ortalama PaCO2 (38,62-42,34) (p <0,001) artış anlamlı düzeyde değildi. Blok sonrası, 12 hastada Horner sendrom bulguları, 6 hastada hipotansiyon-bradikardi gözlendi. Dört hastada ise ses kısıklığı gelişti. Sonuç: İnterskalen brakial pleksus bloğu tek taraflı hemidiyafragmatik pareziye neden olarak solunum fonksiyonlarını ve arteriyel oksijen basıncını etkiler ve bu sebeple pulmoner hastalığı veya kardiyak patolojisi olan hastalar için risklidir.
