Cerrahi Tıp Bilimleri Bölümü

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The association of allergic rhinitis severity with neutrophil-lymphocyte and platelet-lymphocyte ratio in children
(Northern Clinics of İstanbul, 2022) Cansever, Murat; Sarı, Neslihan
Objective: The aim of the study was to investigate the relationship between the severity of allergic rhinitis (AR) and neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in pediatric patients. Methods: This study is a retrospective, cross-sectional, and observational study including 200 AR patients and 160 healthy controls. Of the patients, 39% were boys with a mean age of 10.5 years. The study included children with persistent and intermittent AR. Of the controls, 50.6% were boys with a mean age of 10.3 years. We compared NLR and PLR from blood test between study and control groups. They were also compared according to AR severity within the patient group. Results: The NLR was 1.64±1.29 in the study group whereas 1.18±0.31 in the control group. The PLR was 102.72±31.20 in the study group whereas 79.36±11.72 in the control group. When NLR and PLR were compared between groups, we found statistically significant differences in both NLR and PLR (p=0.003, p=0.001, respectively). We found a statistically significant difference when comparing both NLR and PLR in patients with intermittent and persistent AR. These rates increased with disease severity (p=0.000, p=0.000, respectively). Conclusion: Both NLR and PLR are useful markers for the diagnosis and severity of AR. Clinicians can use these markers to assess disease severity in pediatric patients at the beginning of the diagnostic process.
Bacterial Isolation and Antibiotic Susceptibility Test Results from Burn Wound Infection in the Southeastern Anatolia Region of Turkey
(2023) Akelma,Hakan; Demir Yiğit,Yasemin; Yiğit,Ebral
This study was conducted to find the bacterial profile isolated from the wound areas of the patients hospitalized in our burn center, which is the only one in our region and to find the sensitive antibiotics to be used in the treatment. In this study, the culture reports of 395 patients, whose wound culture results were (+), obtained from 1415 patients hospitalized in Gazi Yaşargil Training and Research Hospital burn center between January 2010 and January 2020, were included. Of the 394 patients, 217 (55%) were male and 117 (45%) were female. The average age of the patients is 12,86±17,34 years. The average burn degree is 2,67. In the wound culture results, 70,55% of gram (+) and 28,68% of gram (-) bacteria were found. Candida albicans were found in wound culture growth results with a rate of 0,07%. The most common gram (+) pathogen is Staphylococcus aureus with 23,09% (n: 91). In our study, the resistance rate of Staphylococcus aureus to methicillin was 20,31%. The most common gram (-) pathogen was E. coli with 9,13% (n: 36) and Pseudomonas aeruginosa with 9,13% (n: 36). Gram (+) organisms were mostly isolated with a rate of 78,95% in the culture results of patients who needed intensive care clinically due to infection. Staphylococcus aureus is the most common bacteria with 21,05%. As a result of our study, it was found that the most common cause of burn infection in our region was S. aureus, P. aeruginosa, and E. coli. We hope that the use of broad-spectrum antibiotics that can be effective against these bacteria will contribute to clinical treatment until culture results are available.
Brakial Pleksus Bloğunun Pletismografik Variabilite İndeksi ve Perfüzyon İndeksi ile Değerlendirilmesi
(Harran Üniversitesi, 2021)
Amaç: Blok başarısının değerlendirilmesi için kullanılan geleneksel yöntemler zaman alıcıdır ve hasta kooperasyonuna ihtiyaç duyar. Bu çalışmanın amacı; Perfüzyon İndeksi ve Pletismografik Variabilite İndeksinin brakiyal sinir blokajının başarısını tahmin etmek için kullanılıp kullanılamayacağını değerlendirmektir. Materyal ve metod: Bu çalışmaya 18-65 yaş arası, elektif veya acil cerrahi operasyona alınan 34 hasta dahil edildi. Brakialpleksus bloğu uygulandı. Kardiyak hastalığı, kronik obstrüktif akciğer hastalığı ve astım hastalığı olanlar çalışma dışı bırakıldı. Hastaların yatak başı, noninvaziv, seri pletismografik variabilite indeksi (PVI) ve perfüzyon indeksi (PI) ölçümleri, blok uygulanan elin dördüncü parmak ucundan Radical-97 PulseOksimetre cihazı kullanılarak yapıldı. Bulgular: Blok yapılan koldan ölçülen PVI değerleri karşılaştırıldığında; 0 ile 5. dk, 5. dk ile 10. dk ve 0 ile 10.dk arasındaki farklılık istatistiksel olarak anlamlı bulundu. PI değerleri 0 ve 5.dk, 5 ve 10.dk, 0 ve 10.dk olarak karşılaştırıldığında değişimler istatistiksel olarak anlamlı bulundu. ( p<0.05) Sonuç: Çalışmamızda PI ve PVI değerindeki değişimlerin istatistiksel olarak anlamlı olduğu görüldü. ( p<0.05) PVI ve PI arasında istatistiksel olarak anlamlı korelasyon saptanmadı.
Could the Umbilical Cord Suggest the Method of Anesthesia?
(Galenos Publishing House, 2023)
Objective: We aimed to investigate changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatine kinase-myocardial band (CK-MB), and troponin I levels, which were biochemical parameters that gave an idea regarding clinical conditions such as tissue damage and asphyxia, according to the anesthesia type, to compare their levels in mothers who gave birth with normal spontaneous vaginal delivery (NSVD) and to investigate whether the type of anesthesia applied caused a change in biochemical parameters. Methods: Of the 90 patients included in the present study, 30 (33.3%) underwent general anesthesia, while 30 (33.3%) underwent spinal anesthesia, and 30 (33.3%) gave birth with NSVD. AST, ALT, LDH, CK-MB, and troponin I levels were measured in all pregnant women before they were taken to the operating room or delivery room. After the baby was delivered, a blood sample was taken from the umblical artery to measure AST, ALT, LDH, CKMB, and troponin I levels. The APGAR scores, the need for oxygen, positive pressure ventilation, and intubation after delivery of the newborns were recorded. Results: Statistically significant increases were found in AST, ALT, LDH, and troponin I levels in umblical artery in all groups when compared with their levels in pregnant women before delivery. Conclusion: An increase in umbilical artery CK-MB and ALT levels was observed in the NSVD group. Due to the increase in umbilical artery CK-MB and ALT levels in the NSVD group, it was found that it was not appropriate to evaluate the effects of anesthesia on the newborn with these markers
The Effect of Lumbar Disc Hernia Operations in Prone Position on Endotracheal Cuff Pressure and Tracheal Morbidity
(2023) İpek,Yusuf; Baysal Yıldırım,Zeynep; Çelik,Enes; Akelma,Hakan
Background: When the cuffs of endotracheal tubes are inflated with high pressure, serious morbidities are encountered. The aim of our study is to monitor the values of endotracheal tube cuff pressure, which can change in different positions, during the operation and to investigate its effects on tracheal morbidity. Materials and Methods: Prospective observational study. The age at which general anesthesia with endotracheal intubation was applied to the study; Sixty randomly selected patients in the ASA 1-2 group, 18-80 years old, and Mallampati class 1-2 were included between July 2016 and July 2017. Thirty patients with lumbar disc herniation surgery were divided into 2 groups as group 1 in the prone position, and group 2 in the supine position of 30 patients with lower or upper extremity surgery. After the patients in both groups were intubated in the supine position, the pilot balloon was inflated with an endotracheal cuff manometer between 28-30 cmH2O. Endotracheal tube cuff pressure was continuously monitored throughout the entire operation and recorded every 5 minutes. The patients were evaluated in terms of cough, dysphonia and sore throat at 1, 8 and 24 hours postoperatively. Results: Hemodynamic and respiratory parameters and temperature values of the groups were recorded during the operation. Cuff pressures, postoperative cough, hoarseness and sore throat were statistically significantly higher in group 1 (p:0.0001). Conclusion: In order to minimize tracheal morbidity and related complications that may develop due to endotracheal intubation, it was concluded that cuff pressure monitoring should become standard and continuous measurement is required, especially in operations in the prone position.
Evaluation of Children with Hearing Loss in a Special Education Centre in Mardin by TEDIL-3 Test
(Kulak Burun Boğaz ve Baş Boyun Cerrahisi, 2022) Sarı, Neslihan; İmrak, İbrahim Halil
ABS TRACT Objective: To assess the conditions based on Early Language Development Test (TEDIL-3) scores after rehabilitation in children with hearing loss who continue special education in a single centre in Mardin, a city in southeast Türkiye. Material and Methods: Demography, auditory findings, depression status of 53 (53% male, 47% female, aged 3-7 years) children, given a special education, in July and October 2021, were evaluated by TEDIL-3 test. Group P consisted of patients with scores above average and F group consist of children having scores below average on the TEDIL-3 test. Scores in different characteristics and between groups were compared with analysis of correlations and factor analysis. Results: As a result of the study, 30 (57%) children have been found to be in Group P, 23 (43%) of them in Group F. Statistical significance and higher scores were seen in children with families with monolanguage than bilanguage (p<0.05). Diagnosis age was higher in Group F (mean±SD; 18.5±18.1) than group P (mean±SD; 7.5±11.4). Cochlear implant age was correlated with diagnostic age (p=0.013, n=35, r=0.64). Although neonatal hearing screening (NHS) does not have prognostic significance, in the NHS, 41.5% of children were false positives and 7.5% of them had no application to NHS (p>0.05). Conclusion: Bilingualism and the higher age of diagnosis in hearing loss are major negative factors that we encounter in the auditory rehabilitation by TEDIL scores in Mardin. Correct and compulsory implementation in NHS and raising awaireness on both issues will contribute to auditory rehabilitaion in children in Mardin
Evaluation of Early and Midterm Mitral Valve Repair Results in Consecutive Severe Mitral Regurgitation Patients
(PROGRESS IN NUTRITION, 2022) Uygur, Feragat; Deniz, Hayati
Study Objectives: Surgical valve repair for mitral regurgitation has significant advantages over valve replacement. In this study, we aimed to investigate the early and mid-term results of mitral valve repair using current techniques in order to find out independent risk factors affecting the early and mid-term outcomes. Methods: We retrospectively studied firstly 192 consecutive adult patients (mean age: 43.2±12.3; 120 females and 72 males) who underwent primary mitral valve repair between January 2012 and July 2018. Risk factors affecting the need for re-operations and late survival were determined via univariate and multivariate analyses. Actuarial survival and event-free curves were compared by linear regression analysis. Results: Operative mortality was 2.6% (5 deaths 0–30th. postoperative day (POD). Late mortality was 3.7% (7/187). Reoperation was required in 16 (8.3%) patients. Kaplan–Meier actuarial survival was 95.8%±2.3% at a mean of 43 months. Survival free from reoperation was 92.8%± 4.2% at 60 months. Multivariate analysis demonstrated that residual NYHA class III and IV, low preoperative ejection fraction, and ischemic MR were independent predictors of mortality. Conclusion: We concluded that mitral valve repair showed excellent survival (except ischemic MR), acceptable re-operation rate with satisfactory valve function in a mid-term follow-up period.
Hydrogel burn dressing effectiveness in burn pain
(Elsevier, 2023) Çelik, Enes; Akelma, Hakan
Severe burns are painful and dramatic injuries. Studies show that pain is underestimated and often not adequately treated. This study aims to evaluate the analgesic efficacy of hydrogel burn dressing and silver sulfadiazine, which are two agents commonly used in first-aid dressings for burn patients. This study, designed as a prospective, observational, and cross-sectional study. Study included 64 pediatric patients admitted to our burn center between 01.03.2020 and 01.09.2020 who were examined by our burn service after their first treatment in the emergency dressing room. Two groups of patients were included in the study. Pain level was assessed in the dressing room before and 10 min after the procedure using the Visual Analog Scale and FLACC (Face, Legs, Activity, Cry, Consolability) pain assessment scales.During the study period, Burnaid® was applied to 62.5% of patients (40 patients) and silver sulfadiazine to 37.5% (24 patients). In terms of pain scores, pre-dressing FLACC values were higher in Group B (p = 0.039); post-dressing VAS and FLACC values were significantly lower in group B (p 0.001; p 0.001). In terms of additional analgesia, we found more patients in Group S received analgesics (p 0.001).We believe that its effect on burn wound pain is superior to that of silver sulfadiazine.
Hyperbilirubinemia is a predictor of appendiceal perforation in children: A meta-analysis
(Academic Journal of Health Sciences, 2023) Azizoğlu, Mustafa; Okur, Mehmet Hanifi; Aydoğdu, Bahattin; Orbay, Tuğçe Merve; Bakir, Ayten Ceren; Klyuev, Sergey Alexandrovich; Bilici, Salim; Bayram, Salih
Objective: In this meta-analysis, our goal was to examine the diagnostic utility of bilirubin in identifying complicated from uncomplicated pediatric appendicitis. Materials and methods: Using the databases Embase, PubMed, Scopus, and Cochrane, we carried out a thorough literature search up to 2022. Studies comparing complicated appendicitis (CA) and simple appendicitis (SA) in terms of hyperbilirubinemia in the pediatric population were included. Results: A total of 5 studies with 2740 acute appendicitis patients (1097 complicated appendicitis and 1643 simple appendicitis) were included in this meta-analysis. Five studies have discussed the diagnostic value of total bilirubin (TB). When compared to simple appendicitis, complicated appendicitis had a significantly higher TB count (I2 =94%), (WMD=0.18, 95% CI -0.00 to 0.37; P=0.05), DB count (I2 =0%), (WMD=0.11, 95% CI 0.04 to 0.18; P=0.002), and IB count (I2 = not applicable), (WMD=0.04, 95% CI 0.01 to 0.07; P=0.02). Conclusions: In conclusion, in this meta-analysis, total bilirubin, direct bilirubin, and indirect bilirubin values were higher in complicated appendicitis compared to simple appendicitis. Both total bilirubin and direct bilirubin can be used as diagnostic parameters in childhood appendicitis to differentiate complicated appendicitis from simple appendicitis.
Laparoscopic versus open portoenterostomy for treatment of biliary atresia: a meta-analysis
(SpringerLink, 2023) Bilici, Salim; Mehmet Hanif Okur, Bahattin Aydoğdu, Mustafa Azizoğlu, Salim Bilici, Salih Bayram, Fikret Salik
Abstract Objective Our goal was to compare laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia. Materials and methods Using the databases EMBASE, PubMed, and Cochrane, we carried out a thorough literature search up to 2022. Studies comparing laparoscopic and open surgery for the treatment of biliary atresia were included. Results Twenty-three studies comparing laparoscopic portoenterostomy (LPE) (n=689) and open portoenterostomy (OPE) (n=818) were considered appropriate for meta-analysis. Age at surgery time was lower in the LPE group than OPE group (I 2=84%), (WMD − 4.70, 95% CI − 9.14 to − 0.26; P=0.04). Signifcantly decreased blood loss (I 2=94%), (WMD − 17.85, 95% CI − 23.67 to − 12.02; P<0.00001) and time to feed were found in the laparoscopic group (I 2=97%), (WMD − 2.88, 95% CI − 4.71 to − 1.04; P=0.002). Signifcantly decreased operative time was found in the open group (I 2=85%), (WMD 32.52, 95% CI 15.65–49.39; P=0.0002). Weight, transfusion rate, overall complication rate, cholangitis, time to drain removal, length of stay, jaundice clearance, and two-year transplant-free survival were not signifcantly diferent across the groups. Conclusions Laparoscopic portoenterostomy provides advantages regarding operative bleeding and the time to begin feeding. No diferences in remain characteristics. Based on the data presented to us by this meta-analysis, LPE is not superior to OPE in terms of overall results.
Maksillofasiyal Travma ve Zor Havayolu Yönetimi: İki Olgu Sunumu
(Mardin Artuklu Üniversitesi, 2022)
Giriş ve Amaç: Maksillofasiyal travmalı hastalarda bozulan anatomi ve travmaya sekonder gelişen ödem nedeniyle hava yolu yönetimi hızla müdahale edilmesi gereken bir durumdur. Travma hastasının değerlendirilmesinde ve yönetilmesinde öncelikle, hava yolu güvenliği sağlanmalı ve servikal omurga stabilize edilmelidir. Bu yazıda; ateşli silah yaralanması sonucu maksillofasiyal travma gelişen iki olguda uygulanan anestezi yönetiminin literatür eşliğinde tartışılması amaçlandı. Gereç ve Yöntem: Bu çalışmada iki hastanın hastane bilgi sistemindeki kayıtları ve anestezi kayıtları incelendi. Hastaların perioperatif özellikleri, cerrahi endikasyonu, anestezi tekniği ve komplikasyonları kaydedildi. Bulgular ve Sonuç: Maksillofasiyal travmalı hastalar; yüz kemikleri ve yumuşak dokulardaki hasarlanmaya bağlı olarak kısa sürede gelişebilen hava yolu ödemi, kan, pıhtı, yabancı cisim, kırık kemik fragmanları gibi hasarlı doku veya travmaya neden olan ana materyalin hava yolunu kapatabilmesinden kaynaklı aspirasyon riski nedeniyle hızla hava yolunun garantiye alınması gereken özellikli hasta grubudur. Yazımızda ateşli silah yaralanması sonucu maksillofasiyal travma gelişen iki olgudaki hava yolu yönetimini tartışmayı amaçladık.
Oxidative Stress Enzyme NOX1 Is a New and Important Biomarker for Childhood Appendicitis?
(SpringerLink, 2023) Avcı, Veli; Ayengin, Kemal; Huyut, Zubeyir; Huyut, Mehmet Tahir; Soysal, Lokman; Bilici, Salim
Delayed appendicitis diagnosis may result in perforation and an increased risk of mortality. This study aimed to assess the diagnostic value of ischemia-modifed albumin, nicotinamide adenine dinucleotide phosphate oxidase 1, 2, and 4 levels in the diagnosis of non-complicated and complicated appendicitis. The study included 60 pediatric patients who presented to our clinic with a complaint of abdominal pain and underwent surgery with a diagnosis of appendicitis between November 2020 and December 2021 and also included 30 controls. Cases were divided into three groups: (i) non-complicated appendicitis (n = 30), (ii) complicated appendicitis (n = 30), and (iii) control (n = 30). The nicotinamide adenine dinucleotide phosphate oxidase 1 and 4 and ischemia-modifed albumin levels were higher in non-complicated and complicated appendicitis compared to the control (p < 0.001). In addition, considering the odds ratio values, the most efective biomarkers in the diagnosis were nicotinamide adenine dinucleotide phosphate oxidase 1 and 2, and procalcitonin, while the most efective biomarkers in the prognosis were nicotinamide adenine dinucleotide phosphate oxidase 1 and 2, and neotrophil/lymphocyte ratios. The data suggested that since the most successful biomarker nicotinamide adenine dinucleotide phosphate oxidase 1, with a value of 0.98- area under the curve, is the most successful biomarker in both diagnosis and prognosis of the disease, it can be used as an important biomarker in childhood appendicitis.
Oxidative stress, apoptosis, inflammation, and proliferation modulator function of visnagin provide gonadoprotective activity in testicular ischemia-reperfusion injury
(Verduci Editore srl, 2023) Sağır, Süleyman; Şeker, Uğur; Pekince Özener, Merve; Yüksel, Meral; Demir, Mehmet
OBJECTIVE: Visnagin (Vis) is a compound found in the flowers and seeds of the Ammi visnaga plant with promising antioxidant and anti-inflammatory properties. We aimed to investigate the dose-dependent gonadoprotective effects of visnagin in rats while considering oxidative stress, apoptosis, and inflammation-related protein expression levels. MATERIALS AND METHODS: Twenty-eight adult rats were divided into four groups of seven animals each; control, ischemia/reperfusion (I/R), I/R+30Vis, and I/R+60Vis. Animals in control received no surgical application and were sacrificed at the end of the experiment. The rats in I/R, I/R + Vis30, and I/R + Vis60 were exposed to testicular ischemia and the animals in I/R + Vis30, and I/R + Vis60 groups received either 30 or 60 mg/kg visnagin intraperitoneal. At the end of the experiment, testis tissues were used for the measurement of oxidative stress, apoptosis, and inflammation. RESULTS: Our microscopic examinations indicated that I/R resulted in testicular degenerations and morphological alterations, which were improved in visnagin-treated animals. The biochemical analyses demonstrated that oxidative stress in the I/R group increased significantly (p<0.05) compared to the control group. The immunohistochemical examinations showed that pro-apoptotic Bax and Caspase 3 expressions, and pro-inflammatory tumor necrosis factor-alpha (TNF-α) levels were significantly up-regulated (p<0.05) but proliferating nuclear antigen (PCNA) levels in I/R group was significantly (p<0.001) down-regulated compared to the control group. CONCLUSIONS: Ischemia leading to testicular torsion is a reproductive health-affecting problem, and current surgical treatment methods might be insufficient to recover the testis due to the accumulation of reactive oxygen species (ROS). Our observations indicate that visnagin is a potential co-modality along with the surgical interventions for the recovery of ischemia encountered testis, but we believe the requirement of more detailed studies to explore the underlying signaling pathways and the strength of visnagin against testicular ischemia-reperfusion injury.
Postpartum Anorektal Hastalık Sıklığında Gebelikte Alınan Kilo Etkili midir?
(Harran Üniversitesi Tıp Fakültesi Dergisi, 2023)
GİRİŞ: Tromboze eksternal hemoroid (TEH) ve anal fissür gebelik sırasında ve postpartum dönemde hayat kalitesini ciddi şekilde bozan benign anorektal hastalıklardandır. Bu lezyonların toplumdaki gerçek insidansı ve gebelikle progrese olması arasındaki ilişki yeterince bilinmemektedir. Çalışmamızın amacı gebeliğin son trimesterı ile postpartum birinci aya kadar gelişen TEH ve anal fissür insidansını saptamak ve bu durumun gebelik boyunca alınan kilo, yenidoğan ağırlığı ve doğumun ikinci fazındaki süre ile olan ilişkisini ortaya koyabilmektir. MATERIAL VE METHOD: 25 Temmuz 2021- 25 Ekim 2021 tarihleri arasında kadın doğum ve genel cerrahi polikliniğine başvuran gebe hastalar içinden üçüncü trimester ve postpartum birinci ayda TEH ve anal fissür görülen, kayıtları tam olan hastalar prospektif takip edilip retrospektif analiz edildi. Üçüncü trimesterda olan hastaların kilo artışı yüzde olarak hesaplandı. Tüm üçüncü trimester hamile hastalar asemptomatik iken ve postpartum ilk ayda, kadın doğum uzmanı veya genel cerrah tarafından en az üç kez muayene edildiler. Daha önceden hemoroidal hastalık nedeniyle operasyon öyküsü olan hastalar çalışmaya dahil edilmedi. BULGULAR: TEH gelişen hastalarda; gebelik sırasında kilo artışı, bebek doğum ağırlığı, doğumun ikinci fazının uzaması risk faktörleri olarak saptandı (sırası ile p=0,003 p<0,001 p<0,001 p<0,001). Anal fissür risk faktörleri arasında ise gebelikte kilo artışı, bebek doğum ağırlığı, doğumun ikinci fazının uzaması saptandı (sırası ile p=0,003 p<0,001 p<0,001 p<0,001). İlk doğumun normal spontan vajinal doğum olması ve gebelik öncesi kilo fazlalığının TEH ve anal fissür sıklığında bir artışa neden olmadığı gözlemlendi. Sonuç: Gebelikte kilo alımı, bebek doğum ağırlığı ve doğumun ikinci fazının uzaması TEH ve anal fissür gibi Anorektal hastalıkların gelişimi açısından risk faktörü olarak sayılabilir.
Sık Görülen Pediatrik Konjenital Sendromlarda Anestezi
(Turkiye Klinikleri (Ortadogu Reklam Tanitim Yayincilik Turizm Egitim Insaat Sanayi A.S.), 2023)
Konjenital sendromlu çocuk hastalar nadir hastalıklar olsa da uzmanlık eğitimi aldığımız sağlık kuruluşlarında bu hasta grubu ile karşılaşmaktayız. Konjenital sendromlu çocuklarda anestezi açısından önemli birçok özellik bulunabilir. Zor hava yolu sıklığında artış, hipertansiyon, subglottik stenoz, obstrüktif uyku apnesi, epilepsi sıklığında artış gibi anestezi yönetiminde önemli özellikleri olabilir. Konjetinal sendromlu çocuklarda anestezi yönetimi özellikli ve zorlu olabileceğinden preoperatif dönemden başlayarak hazırlıklı olunmalıdır.
Tek Akciğer Ventilasyonun Kognitif Fonksiyonlar Üzerine Etkisi: Kesitsel Araştırma
(Türkiye Klinikleri (Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.), 2023)
Amaç: Postoperatif kognitif disfonksiyon (POKD), majör cerrahi sonrası özellikle ileri yaş olmak üzere tüm yaş grubu hastalarda sıkça görülür ve aylarca sebat edebilir. Etiyolojisi multifaktöriyel olmakla birlikte, serebral oksijen sunum ve tüketim dengesini etkileyen faktörler suçlanmaktadır. Bu nedenle hipoksi gibi ciddi komplikasyonlarla seyredebilen tek akciğer ventilasyonu (TAV) uygulanan torasik cerrahi hastalarında POKD'yi mini-mental durum testi ile değerlendirerek hastalarda POKD'nin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu çalışmaya 20 yaş ve 72 yaş arası, torasik cerrahide TAV adayı hastalar dâhil edildi. Anestezi protokolü tüm hastalarda aynı şekilde uygulandı. Kognitif değerlendirme operasyondan 1 gün önce, operasyondan 1 ve 3 gün sonra yapıldı. Bu amaçla MiniMental Durum Değerlendirme Testi kullanıldı. Bulgular: Çalışmaya 30 hasta dâhil edildi. TAV uygulanan hastaların %26,6'sında POKD tespit edildi. Hastaların yapılan mini-mental durum değerlendirme testi, ameliyat öncesi ile ameliyat sonrası 1. gün ile 3. gün arasında kognitif disfonksiyon açısından fark tespit edildi. Ameliyat sonrası 1. gün ile ameliyat sonrası 3. gün arasında fark tespit edilmemiştir. Sonuç: Toraks cerrahisinde TAV uygulanan hastalarda erken dönem kognitif disfonksiyon görülmektedir. Bunda cerrahi süre, anestetik ilaçlar, hastayla ilgili parametreler etkili olmakta olup, hastalar intaroperatif yakın takip edilmeli ve ameliyat sonrasında da hastalar kognitif fonksiyonları açısından yakından izlenmelidir.
Tek Akciğer Ventilasyonun Kognitif Fonksiyonlar Üzerine Etkisi: Kesitsel Araştırma
(Türkiye Klinikleri, 2023) Aydoğan, Mesut; Çelik, Enes; Yıldırım, Zeynep Baysal; Kuyumcu, Mahır
Amaç: Postoperatif kognitif disfonksiyon (POKD), majör cer- rahi sonrası özellikle ileri ya ş olmak üzere tüm ya ş grubu hastalarda sıkça görülür ve aylarca sebat edebilir. Etiyolojisi multifaktöriyel ol- makla birlikte, serebral oksijen sunum ve tüketim dengesini etkileyen faktörler suçlanmaktadır. Bu nedenle hipoksi gibi ciddi komplikas- yonlarla seyredebilen tek akciğer ventilasyonu (TAV) uygulanan tora- sik cerrahi hastalar ında POKD’yi mini-mental durum testi ile değerlendirerek hastalarda POKD’nin de ğerlendirilmesi amaçlandı. Gereç ve Yöntemler: Bu çalışmaya 20 yaş ve 72 yaş arası, torasik cer- rahide TAV adayı hastalar dâhil edildi. Anestezi protokolü tüm hasta- larda aynı şekilde uygulandı. Kognitif değerlendirme operasyondan 1 gün önce, operasyondan 1 ve 3 gün sonra yap ıldı. Bu amaçla Mini- Mental Durum De ğerlendirme Testi kullan ıldı. Bulgular: Çalışmaya 30 hasta dâhil edildi. TAV uygulanan hastalar ın %26,6’sında POKD tespit edildi. Hastaların yapılan mini-mental durum değerlendirme testi, ameliyat öncesi ile ameliyat sonrası 1. gün ile 3. gün arasında kognitif disfonksiyon açısından fark tespit edildi. Ameliyat sonras ı 1. gün ile ameliyat sonrası 3. gün arasında fark tespit edilmemiştir. Sonuç: Toraks cerrahisinde TAV uygulanan hastalarda erken dönem kognitif dis- fonksiyon görülmektedir. Bunda cerrahi süre, anestetik ilaçlar, hastayla ilgili parametreler etkili olmakta olup, hastalar intaroperatif yakın takip edilmeli ve ameliyat sonrasında da hastalar kognitif fonksiyonları açı- sından yakından izlenmelidir.
Yoğun Bakım ve Bilinci Kapalı Hasta İle İletişim
(AKADEMİSYEN YAYINEVİ, 2023)
Yoğun bakım hastaları ile iletişim ile ilgili henüz kabul görmüş genel bir yaklaşım bulunmamaktadır. Yeni yayınlarda özellikle teknolojik gelişmelerden yararlanılması dikkat çekmektedir. Hasta yakınlarının bir çok yayında yeteri kadar bilgilendirilmediklerini düşündüğü vurgulanmıştır. Çoğu hasta yakını ve yoğun bakımdan taburcu olan hastada posttravmatik stres bozukluğu yaşandığı belirtilmiştir. Tüm dünyada bu konudaki eksiklikler çalışmalara konu olmuştur. Hemşire ve doktorların standart eğitim müfredatlarının bu konuda eksik katıldığı eleştirilmektedir. Bu sebeple yoğun bakım ünitesi çalışanları iletişim konusunda ek eğitimler almalı ve eğitimde öğrendiklerini günlük pratiklerine eklemelidir. Hasta yakınlarına anlaşılır ve kapsamlı bilgi verilmelidir. Soru sormaları teşvik edilmelidir. Bu amaçla multidisipliner ekipler kurulabilir. Yoğun bakımlarda hasta ve yakını ile iletişime önem verilmesi yanında ekip içi iletişime de dikkat edilmelidir. Ekibe yeni dahil olanların korkmadan, çekinmeden soru sorabileceği ortam sağlanmalıdır.

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