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Yayın The antimicrobial activity of ephedrine and admixture of ephedrine and propofol: an in vitro study [A atividade antimicrobiana de efedrina e da combinação de efedrina e propofol: um estudo in vitro](Elsevier Editora Ltda, 2018) Tulgar S.; Alasehir E.A.; Selvi O.Introduction Propofol and Ephedrine are commonly used during anesthesia maintenance, the former as a hypnotic agent and the later as a vasopressor. The addition of propofol to ephedrine or administration of ephedrine before propofol injection is useful for decreasing or preventing propofol related hemodynamic changes and vascular pain. This in vitro study evaluated the antibacterial effect on common hospital-acquired infection pathogens of ephedrine alone or combined with propofol. Material and method The study was performed in two stages. In the first, the Minimum Inhibitory Concentration of propofol and ephedrine alone and combined was calculated for Escherichia coli, Enterococcus faecium, Staphylococcus aureus, Pseudomonas aeruginosa, and a clinical isolate of Acinetobacter spp. at 0, 6, 12 and 24 h, using the microdilution method. In the second stage, the same drugs and combination were used to determine their effect on bacterial growth. Bacterial solutions were prepared at 0.5 MacFarland in sterile 0.9% physiological saline and diluted at 1/100 concentration. Colony numbers were measured as colony forming units.mL-1 at 0, 2, 4, 6, 8, 10 and 12th hours. Results Ephedrine either alone or combined with propofol did not have an antimicrobial effect on Escherichia coli, Enterococcus faecium or Pseudomonas aeruginosa and this was similar to propofol. However, ephedrine alone and combined with propofol was found to have an antimicrobial effect on Staphylococcus aureus and Acinetobacter species at 512 mcg.mL-1 concentration and significantly decreased bacterial growth rate. Conclusion Ephedrine has an antimicrobial activity on Staphylococcus aureus and Acinetobacter species which were frequently encountered pathogens as a cause of nosocomial infections. © 2017 Sociedade Brasileira de AnestesiologiaYayın Can unilateral erector spinae plane block result in bilateral sensory blockade?(Springer New York LLC, 2019) Tulgar S.; Selvi O.; Ahiskalioglu A.; Ozer Z.…Yayın The combination of modified pectoral nerves block and rhomboid intercostal block provides surgical anesthesia in breast surgery(Elsevier Inc., 2019) Tulgar S.; Kiziltunç B.; Thomas D.T.; Manukyan, Manuk Norayık; Ozer Z.…Yayın Do early procalcitonine levels aid in predicting mortality in burn patients?(E-Century Publishing Corporation, 2016) Piroglu I.D.; Tulgar S.; Piroglu M.D.; Thomas D.T.; Karakilic E.; Gergerli R.; Ates N.G.; Demir A.Aim: Burn patients in intensive care units (ICU) are at high risk of mortality. Our aim in this stuy is to evaluate the use of first 48 hour procalcitonin level (PCT), C-reactive protein (CRP) and APACHE II score for the prediction of mortality in burn patients admitted to ICU. Material and method: Files of patients with burns admitted to a tertiary centre’s burn unit were retrospectively analysed and those with procalcitonin and C-reactive protein level measurements and APACHE II scores within first 48 hours of admittance were included in this study. Patients with comorbidities that would effect PCT and CRP levels such as chronic renal or liver failure were excluded from the study. Patients PCT, CRP and APACHE II scores were compared with the outcome of patients. Results: Seventy patients were included in this study. While CRP levels were lower in patients that were deceased, PCT levels were significantly higher in these patients. In patients with APACHE II score > 20 and PCT > 2 ng/ml, mortality was statistically very significantly higher compared with other patients. Logistical regression analysis showed that high PCT levels and APACHE II scores were important at predicting mortality in these patients. Conclusion: High PCT levels within 48 hours of burns is a predictor of mortality in these patients. Additional studies are required to correctly determine the cut-off value. A modified scoring system including APACHE II and PCT may be useful for better predicting mortality, although larger multi-centered studies are required. © 2016, E-Century Publishing Corporation. All rights reserved.Yayın The effect of smoking on neutrophil/ lymphocyte and platelet/lymphocyte ratio and platelet indices: A retrospective study(Verduci Editore, 2016) Tulgar Y.K.; Cakar S.; Tulgar S.; Dalkilic O.; Cakiroglu B.; Uyanik B.S.OBJECTIVE: Smoking commonly leads to death. Although the neutrophil/lymphocyte Ratio, platelet/lymphocyte ratio and platelet indices have been shown to be important for the diagnosis, prognosis and severity of some diseases, the smoking status of patients in these studies has not been well defined. In this study, we compared ratios derived from complete blood count and platelet indices to smoking status and length in smokers and non-smokers. PATIENTS AND METHODS: The data of healthy males and females aged between 18-60 years who presented to our institute for a routine check-up were collected, and subjects were divided in two groups - smokers and non-smokers. The presence of medical history or laboratory results which could affect inflammatory response, formed our exclusion criteria. All complete blood count results were noted and persons' smoking habits were calculated as pack/years. RESULTS: White blood cell, neutrophil, basophil and eosinophil counts; mean corpuscular volume, red cell distribution width and neutrophil/lymphocyte ratio were significantly higher in smokers when compared to non-smokers (p<0.05). When smokers were grouped according to smoking habits; positive linear correlations were detected between pack/year and Neutrophil/lymphocyte ratio and also pack/year and plateletcrit in smokers (p<0.05). CONCLUSIONS: Neutrophil/lymphocyte ratio increases in correlation with pack/year while platelet/lymphocyte ratio is not affected and platelet distribution width is increased in smokers. If smokers are not excluded from studies evaluating neutrophil/lymphocyte ratio and platelet distribution width, the relationship between smoking status as well as pack/year must be determined and reported.Yayın Evaluation of ultrasound-guided transversalis fascia plane block for postoperative analgesia in cesarean section: A prospective, randomized, controlled clinical trial(Elsevier Inc., 2020) Serifsoy T.E.; Tulgar S.; Selvi O.; Senturk O.; Ilter E.; Peker B.H.; Ozer Z.Study objective: Cesarean Delivery (CD) is a commonly performed obstetric procedure. Adding a regional anesthesia technique to multimodal analgesia in CD, may improve the quality of postoperative analgesia. In this study we evaluated the efficacy of Transversalis Fascia Plane Block (TFPB) for postoperative analgesia management in CD. Design: Blinded, prospective, randomized study. Setting: Postoperative recovery room & ward, tertiary university hospital, Istanbul, Turkey, Patients: Seventy-five patients (ASA II-III) scheduled to undergo Cesarean delivery were recruited. Following exclusion, 70 patients were randomized into two equal groups (block and control group). Interventions: Standard multimodal analgesia (routine paracetamol and tramadol PCA in addition to diclophenac sodium as rescue analgesia) was performed in Group C while TFPB block was also performed in the intervention (TFPB) group. Measurements: The primary outcome was tramadol consumption within the first 24 h. The secondary outcome was Numeric Rating Scale (NRS) scores during rest and movement/coughing. Main results: Tramadol consumption in the first 24 h was 175 ± 72.32 mg in the control and 101.42 ± 51.45 mg in the TFPB group (p < 0.05). NRS was lower in Group TFPB during the first 3 h and at the 12th hour. There was no difference in NRS scores at other hours. Conclusion: Bilateral ultrasound guided TFPB leads to effective analgesia and a decrease in analgesia requirement in first 24 h in patients undergoing CD. © 2019 Elsevier Inc.Yayın How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: A retrospective study(Verduci Editore, 2016) Furuncuoglu Y.; Tulgar S.; Dogan A.N.; Cakar S.; Tulgar Y.K.; Cakiroglu B.OBJECTIVE: Obesity is an important preventable cause of death and is a major risk factor for cardiovascular diseases as well as skeletal system diseases and malignancies. In many studies, complete blood count (CBC) and ratios derived from its results - such as the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and systemic immune inflammatory index have been associated with some diseases and their surveys. In these studies, the body mass index (BMI) and state of obesity of patients and the possible effects of these factors on CBC have not been defined. In this study, our aim was to evaluate the effect of BMI and smoking on CBC and ratios derived from CBC. PATIENTS AND METHODS: In this cross-sectional, retrospective study; the data of male and female patients aged between 18-65 years who presented for a routine check-up or obesity was collected and subjects were grouped as normal weight, overweight, obese and morbidly obese accordingly BMI. Persons' smoking habits were calculated as pack/years. All complete blood count results were noted. Smoking status and BMI groups were compared to CBC findings and ratios derived from these findings. RESULTS: After exclusion, 223 participants' data (104 female and 119 male) was included in the study. BMI was found to have a statistically significant positive linear correlation with lymphocyte number, PDW, SII and RDW (p < 0.05), and an extremely significant positive linear correlation (p < 0.01) was found between BMI and WBC, neutrophil count, PCT and platelet count. When BMI was not considered and 135 smokers were compared to 88 non-smokers, leukocytes and neutrophil counts were found to be higher in smokers (p < 0.05). CONCLUSIONS: Our study has found that WBC, neutrophil count, lymphocyte count, platelet count, PCT, PDW and SII are significantly affected by BMI status. Future studies that use these parameters and indices must take the participants' BMI and smoking status into account.Yayın The impact of intravenous lipid emulsion on lipophilicity in poisoned patients: A systematic review(Scientific Publishers of India, 2017) Karakılıç E.; Kaya E.; Erdem A.; Arslan E.D.; Durdu T.; Tulgar S.; Işcanlı D.Objective: Although the action mechanism of intravenous lipid emulsion has not been fully elucidated yet, its use in liposoluble drugs intoxications. In this study, we examined the lipophilic features of causative agents and the success of the treatment ILE therapy in intoxication cases. Methods: We reviewed 765 cases published in PubMed between 1966 and June, 2015. After applying exclusion criteria, totally 141 cases ingested single substance and received ILE therapy with 20% ILE solution were included in present study. Amount of lipid solutions given and the results were recorded. Success rate was statistically assessed according to log p values of the substances taken and the amount of lipid emulsion used. Results: 141 patients were involved in this study; log p values were calculated for all drugs regardless of the success of ILE therapy. ILE therapy under the amount of 100 ml failed to achieve successful outcome. ALOGPS and ChemAxon log P values were higher in cases, which received ILE therapy ? 500 ml and showed successful results. It was found that log p value had no contribution to the treatment success in the group received ILE therapy>500 ml. Conclusions: It was found that ILE therapy<500 ml was successful in drugs with higher lipophilicity while success rate was higher in ILE therapy>500 ml and that liposolubility had no significant contribution to treatment success. © 2017, Scientific Publishers of India. All rights reserved.Yayın A new technique for sensory blockage of posterior branches of sacral nerves: Ultrasound guided sacral erector spinae plane block(Elsevier Inc., 2019) Tulgar S.; Senturk O.; Thomas D.T.; Deveci, Uğur; Ozer Z.; Deveci, Uğur…Yayın Similarities between external oblique fascial plane block and blockage of thoracoabdominal nerves through perichondral approach (TAPA)(Elsevier Inc., 2019) Tulgar S.; Ahiskalioglu A.; Selvi O.; Thomas D.T.; Ozer Z.…Yayın Use of quips survey for the assessment of quality in postoperative pain management [Postoperatif agri yönetn kaütesinin degerlendirilmesinde quips anketi yönteminin kullanimi](Anestezi Dergisi, 2016) Ozütemiz M.; Selvi O.; Tulgar S.; Özer Z.Objective: Although there are guidelines and advanced pain management techniques, quality of postoperative pain management can not still be measured with a standard method considering safety issues. Many factors like nausea, vomiting, functional disability and immobility have an effect on the achivement of postoperative pain therapy. QUIPS is a survey which takes all these factors into account. In this study we tried to evaluate the quality of postoperative pain management by using QUIPS. Method: This study was conducted on 400 volunteers who were planned for surgical operation between 07.2014 - 01.2015 at Maltepe University Medical Faculty Hospital. QUIPS was applied to these patients the day after the surgery Results: Fifty-four percent (n:216) of the patients were women and 46% (n:184) of them were men. These patients were asked about their pain level in questions 3 and 4. The highest scores for pain were recorded in neurosurgery and orthopedics. In the fifth question patients were asked to answer whether they had immobility problems due to pain and the highest scores were in neurosurgery patients (p<0.01). The most satisfied patients with their pain theraphy were in ENT group. Conclusion: The fact that focusing on only pain revealing therapies are not adequate while approaching towards postoperative pain was the main motivation in preaparation of QUIPS. Beacuse of this fact QUIPS can be used as a useful tool to evaluate pain, pain related symptoms and quality of postoperative pain management.
