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    BERNARD SOULİER SENDROMLU ÇOCUKTA GENEL ANESTEZİ ALTINDA DİŞ TEDAVİSİ
    (2021-11-05T00:00:00Z) Esen, Asım; ESEN, ASIM
    Giriş Bernard Soulier sendromu ilk kez 1948’de bildirilmiş, nadir görülen (yaklaşık 1/1milyon) kalıtsal bir pıhtılaşma bozukluğudur. Bildirilmiş birkaç otozomal dominant geçiş dışında otozomal resesif geçişli, dev trombositler, trombosit sayısında düşüklük ve uzamış kanama zamanı ile karakterizedir. Ortalama teşhis yaşı 16’dır. Etkilenmiş bireyler, kanamanın aşırı olmasına ve spontan ekimozlara eğilimlidirler. Bu sunumda biz, genel anestezi altında diş tedavisi yapılacak 14 yaşında bir olguyu paylaşmak istedik.OlguTanısı 6 aylıkken geçirdiği spontan intrakraniyal kanama sonrasında konulmuş 14 yaşında ve 60 kg ağırlığında erkek hasta dört adet diş çekimi ve dört adet diş tedavisi için ameliyathaneye alındı. Bernard Soulier sendromuna ek olarak faktör 7 eksikliği, intrakraniyal kanama sonrasında aralıklı devam eden epileptik nöbetleri, hafif mental retardasyonu, iletişim kurmada güçlüğü, mitral valv prolapsusu, atriyal septal defekti ve sol pulmoner arterde darlığı mevcuttu. Preoperatif dönemde pediyatrik nöroloji ve kardiyoloji ile konsülte edilen hasta için ek hastalıkları nedeniyle yoğun bakım yatağı rezerve edildi. Kan testleri normal sınırlarda olduğu için preoperatif kan ya da kan ürünü replasmanına ihtiyaç duyulmayan hastaya ameliyathaneye inmeden yarım saat önce endokardit profilaksisi için 1 gr ampisilin intravenöz olarak uygulandı. Yine öneriler doğrultusunda 1 ünite aferez trombosit hazırlandı. Ayrıca pediyatrik nöroloji önerileri doğrultusunda antiepileptik ilaçları düzenlendi. İletişimi sınırlı ve inaktif olan hastaya premedikasyon uygulanmadı. Hastanın anestezisi ve postoperatif derlenme dönemi sorunsuz seyretti. Cerrahi işlem sırasında kanama eğilimi, beklendiği gibi, normal hastalara göre fazlaydı. Diş çekimi en sona bırakıldı. Çekim yapılan alanlara emilebilir hemostatik jelatin sünger konuldu. Bu alanlardaki kanama nedeniyle hemostatik süngerler 3-4 kez değiştirildi. Bu süreç esnasında baskı uygulayarak hemostaza yardımcı olmak için fındık boyutunda gaz kompres uygulandı ve kanama aralıklı olarak kontrol edildi. Derlenme ünitesinde 1 saat gözlendikten sonra sorun olmaması üzerine servise alındı. Ameliyatın ertesi günü pediyatrik nöroloji ve kardiyoloji tarafından tekrar değerlendirilen hasta taburcu edildi.Tartışma ve sonuçBernard Soulier sendromlu hastalarda klinik seyir farklı olabildiğinden, bu hastalar preoperatif dönemde ayrıntılı bir şekilde incelenmeli ve gerekli bölümlerle konsülte edilmelidir. Kanama eğilimi nedeniyle peroperatif yakın hemodinamik takip önemlidir. Ayrıca komorbiditelerin olması durumunda postoperatif dönemde yoğun bakım takibine ihtiyaç duyulabileceği akılda tutulmalıdır. Anahtar kelimeler: Bernard Soulier sendromu, Pıhtılaşma Bozukluğu, Trombosit sayısı
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    Publication
    Comparison of serratus plane block alone and in combination with pectoral type 1 block for breast cancer surgery: a randomized controlled study
    (2022-03-01T00:00:00Z) Yeşiltaş, Serdar; Türköz, Ayda; Çalım, Muhittin; Esen, Asım; Daşkaya, Hayrettin; Karaaslan, Kazım; YEŞİLTAŞ, SERDAR; TÜRKÖZ, AYDA; ÇALIM, MUHITTIN; ESEN, ASIM; DAŞKAYA, HAYRETTİN; KARAASLAN, KAZıM
    Background/Aim: Concurrent application of ultrasound-guided pectoral type 1 (PECS I) and serratus plane block (SPB) is one of the most appropriate multimodal analgesic strategies for reducing acute post-mastectomy pain. The purpose of the present study was to compare the analgesic efficacy of SPB alone, or in combination with PECS I block for postmastectomy pain following breast cancer surgery. Materials and Methods: Sixty participants undergoing breast cancer surgery were randomly assigned to two groups. After anesthesia induction, group S (n =30) received SPB alone, whereas the SPECS group (n =30) received a combination of PECS I and SPB. Pain scores at 0, 1, 2, 6, 12, 24 h postoperatively, intra-operative fentanyl consumption, postoperative time to first rescue analgesia, nausea, vomiting, patient satisfaction, and anesthesia-related complications were recorded. Results: Pain scores in the SPECS group were significantly lower than group S throughout the follow-up period (p <0.001). A significant reduction in postoperative rescue morphine consumption (p =0.01, median difference 7 mg, 95 % confidence interval: 5.1-7.9 mg) and intraoperative fentanyl consumption (p =0.01) in the SPECS group compared with group S. Moreover, postoperative nausea and vomiting were lower, and patient satisfaction was higher in the SPECS group compared with that of the group S. Conclusions: These results suggest that SPB application and PECS I provide more effective and reliable perioperative analgesia and increase patient satisfaction in breast cancer surgery
  • No Thumbnail Available
    Publication
    Anestezi teknikerleri için Anestezi kitabı
    (2014-01-01T00:00:00Z) ESEN, ASIM; ESEN, ASIM
  • No Thumbnail Available
    Publication
    MUKOPOLİSAKKARİDOZ TİP 3 TANISI OLAN HASTADA ANESTEZİ DENEYİMİMİZ: OLGU SUNUMU
    (2022-02-20) Sümer İ.; Esen A.; Uysal H.; SÜMER, İSMAİL; ESEN, ASIM; UYSAL, HARUN
    MUKOPOLİSAKKARİDOZ TİP 3 TANISI OLAN HASTADA ANESTEZİ DENEYİMİMİZ: OLGU SUNUMUDr. Öğr. Üyesi. İsmail SÜMERBezmialem Vakıf Üniversitesi, Tıp FakültesiORCID ID: https://orcid.org/0000-0002-0133-0218drismailsumer@gmail.com, 0533 2201576Dr. Öğr. Üyesi. Asım ESENBezmialem Vakıf Üniversitesi, Tıp FakültesiORCID ID: https://orcid.org/0000-0001-7222-7499esen1122@hotmail.com, 0533 5219455Dr. Öğr. Üyesi. Harun UYSALBezmialem Vakıf Üniversitesi, Tıp FakültesiORCID ID: https://orcid.org/0000-0003-0426-8525drharunuysal@hotmail.com, 0506 3433494ÖzetMukopolisakkaridozlar (MPS), lizozomal enzim eksikliğine bağlı olarak glikozaminoglikan vucutta birikimi ile giden, multisistem tutulum gösteren, kalıtsal, kronik ve ilerleyici bir metabolik depo hastalığıdır. Enzim eksikliğine bağlı olarak biriken maddeler hücrelerin normal işlevlerini bozarlar  ADDIN EN.CITE <EndNote><Cite><Author>Danos</Author><Year>1995</Year><RecNum>7</RecNum><DisplayText>(1)</DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="aawxpsrpzwsf9aewp9gv0xw2frwwvr9afwrx" timestamp="1643717026">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Danos, O.</author><author>Heard, J. M.</author></authors></contributors><auth-address>Laboratoire Rétrovirus et Transfert Génétique, Institut Pasteur, Paris, France.</auth-address><titles><title>Mucopolysaccharidosis</title><secondary-title>Mol Cell Biol Hum Dis Ser</secondary-title></titles><periodical><full-title>Mol Cell Biol Hum Dis Ser</full-title></periodical><pages>350-67</pages><volume>5</volume><edition>1995/01/01</edition><keywords><keyword>Animals</keyword><keyword>Bone Marrow Transplantation</keyword><keyword>Central Nervous System/metabolism</keyword><keyword>Clinical Trials as Topic</keyword><keyword>Disease Models, Animal</keyword><keyword>Genetic Therapy</keyword><keyword>Humans</keyword><keyword>Mucopolysaccharidoses/genetics/physiopathology/*therapy</keyword></keywords><dates><year>1995</year></dates><isbn>1470-0573 (Print)&#xD;1470-0573</isbn><accession-num>9532574</accession-num><urls></urls><electronic-resource-num>10.1007/978-94-011-0547-7_17</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(1). Mukopolisakkaritler bağ doku komponenti oldukları için biriktikleri dokularda farklı etkilere sebep olabilirler. Deri, solunum yolları, santral sinir sistemi kalp, karaciğer, dalak, kemik ve ligamanlarda depolanır ve bu dokular etkilenebilir. Tipik klinik belirtiler; kaba yüz görünümü, kulak burun boğaz problemleri, iskelet displazileri, büyüme gelişme geriliği, servikal instabilite, servikal kord kompresyonu, organomegali, görme ve işitme bozuklukları, eklem kontraktürleri, herniler ve kardiyopulmoner problemler olarak sıralanabilir  ADDIN EN.CITE <EndNote><Cite><Author>Kliegman</Author><Year>2011</Year><RecNum>8</RecNum><DisplayText>(2)</DisplayText><record><rec-number>8</rec-number><foreign-keys><key app="EN" db-id="aawxpsrpzwsf9aewp9gv0xw2frwwvr9afwrx" timestamp="1643717817">8</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Kliegman, R., </author><author>Stanton, B., </author><author>St. Geme, J. W.,</author><author>Schor, N. F.,</author><author>Behrman, R. E. </author><author> </author></authors></contributors><titles><title><style face="normal" font="default" charset="238" size="100%">Nelson Textbook of Pediatrics</style></title></titles><pages><style face="normal" font="default" charset="238" size="100%">480-510</style></pages><volume><style face="normal" font="default" charset="238" size="100%">19th edition</style></volume><dates><year><style face="normal" font="default" charset="238" size="100%">2011</style></year></dates><pub-location>Phialdelphia</pub-location><publisher>Elsevier</publisher><urls></urls></record></Cite></EndNote>(2).MPS tip III olan hastalarda, heparan sülfat yıkımında yetersizlik mevcuttur. Ortak özellikleri hafif somatik bulgularla birlikte yavaş ilerleyen ağır SSS tutulumudur. Bu hastalar genelde MSS tutulumuna bağlı ilerleyici psikomotor gerilik gösterir. Erken dönemde yüzde kabalaşma görülür, nörolojik belirtiler genellikle 2-4 yaş arasında belirlenir  ADDIN EN.CITE <EndNote><Cite><Author>Kliegman</Author><Year>2011</Year><RecNum>8</RecNum><DisplayText>(2)</DisplayText><record><rec-number>8</rec-number><foreign-keys><key app="EN" db-id="aawxpsrpzwsf9aewp9gv0xw2frwwvr9afwrx" timestamp="1643717817">8</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Kliegman, R., </author><author>Stanton, B., </author><author>St. Geme, J. W.,</author><author>Schor, N. F.,</author><author>Behrman, R. E. </author><author> </author></authors></contributors><titles><title><style face="normal" font="default" charset="238" size="100%">Nelson Textbook of Pediatrics</style></title></titles><pages><style face="normal" font="default" charset="238" size="100%">480-510</style></pages><volume><style face="normal" font="default" charset="238" size="100%">19th edition</style></volume><dates><year><style face="normal" font="default" charset="238" size="100%">2011</style></year></dates><pub-location>Phialdelphia</pub-location><publisher>Elsevier</publisher><urls></urls></record></Cite></EndNote>(2).Organ patolojileri nedeniyle sık operasyon gerektiren bu hastaların anestezisi sistemik sorunlar nedeniyle özellik gösterir. Özellikle yüz deformitesi, nazofaringeal mukopolisakkarid birikimi ve eklem-kemik deformitelerine bağlı hava yolu sağlanmasındaki güçlük bu hastalarda sık karşılaşılan bir sorundur  ADDIN EN.CITE <EndNote><Cite><Author>Kamin</Author><Year>2008</Year><RecNum>9</RecNum><DisplayText>(3)</DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="aawxpsrpzwsf9aewp9gv0xw2frwwvr9afwrx" timestamp="1643718047">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kamin, W.</author></authors></contributors><auth-address>Pediatric Pneumology, Allergy, Endoscopy and Cystic Fibrosis Center, Children&apos;s Hospital, University of Mainz, Mainz, Germany. kamin@kinder.klinik.uni-mainz.de</auth-address><titles><title>Diagnosis and management of respiratory involvement in Hunter syndrome</title><secondary-title>Acta Paediatr</secondary-title></titles><periodical><full-title>Acta Paediatr</full-title></periodical><pages>57-60</pages><volume>97</volume><number>457</number><edition>2008/05/28</edition><keywords><keyword>Airway Obstruction/etiology</keyword><keyword>Anesthesia, General</keyword><keyword>Continuous Positive Airway Pressure</keyword><keyword>Forced Expiratory Volume</keyword><keyword>Humans</keyword><keyword>Magnetic Resonance Imaging</keyword><keyword>Mucopolysaccharidosis II/*complications/diagnosis/physiopathology/therapy</keyword><keyword>Respiration Disorders/diagnosis/etiology/*therapy</keyword><keyword>Sleep Apnea, Obstructive/etiology/therapy</keyword><keyword>Spirometry</keyword><keyword>Vital Capacity</keyword></keywords><dates><year>2008</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0803-5253</isbn><accession-num>18339190</accession-num><urls></urls><electronic-resource-num>10.1111/j.1651-2227.2008.00650.x</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(3). Bu hastaların tipik anestezik problemleri; indüksiyon veya ekstübasyon sonrası görülen havayolu obstrüksiyonları, entübasyon zorlukları ve/ veya başarısızlıkları, acil trakeostomi ihtiyaçları, kardiyovasküler ve servikal vertebra sorunlarını içerir ADDIN EN.CITE  ADDIN EN.CITE.DATA 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(4) 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Bu olgu sunumunda, MPS tip 3 tanılı diş cerrahisi geçirecek olan hastanın anestezi yönetiminden bahsedilmiştir.Olgu:Olgumuzda diş tedavisi amacıyla anestezi uygulanan MPS Tip 3 hastası 10 yaşında, 35 kg ağırlığında erkek çocuğu sunulmaktadır. Hastanın fizik muayenesinde büyük kafa ve dil, boyunda hareket kısıtlılığı ve mental retardasyon mevcuttu.(Resim 1) Labaratuvar tetkiklerinde bir sorun yoktu. Anestezi öncesinde çocuk nöroloji, çocuk metabolizma hastalıkları ve çocuk kardiyoloji konsültasyonları istendi. Konvulziyon riski nedeniyle antiepileptiklere devam etmesi, anlantoaksiyal subluksasyon riski nedeniyle entübasyonda dikkatli olunması gerektiği belirtildi. Ayrıca çocuk kardiyoloji tarafından yapılan ekokardiyografide MPS’ye bağlı hafif-orta mitral yetmezlik ve hafif aort yetmezliği tespit edildi. İşlem öncesinde endokardit proflaksisi önerildi.Hastaya işlemden 30 dk önce ampisilin 50 mg/kg uygulandı, başka herhangi bir premedikasyon uygulanmadı, operasyona alınan hasta için zor entübasyon şartları hazırlandı. Rutin monitorizasyonu takiben sol el dorsalinden 24G intraket ile damar yolu açıldı. İndüksiyon 1 mg midozolam, 3 mg/kg propofol ve 1mcg/kg fentanil ile yapıldı. Preoperatif ventilasyon sırasında airway yerleştirildi ve ventilasyonda zorluk yaşanmadı, rocuronyum 0,6 mg/kg uygulandı. Sol burun deliğinden yerleştirilen 5 numara spiralli tüp, video laringoskop ve Magill pensi yardımıyla ilerletilerek hasta nazal olarak entübe edildi.(Resim 2) Genel anestezi idamesi %50-%50 oksijen-medikal hava ve %2 sevofluran ve 0.15-0.3 mg/kg/dk remifentanil infuzyonu ile sağlandı. Postoperatif analjezi için 500 mg IV parasetamol uygulandı. Operasyon sonunda 100 mg sugammadex uygulandı ve ventilasyon problemi olmayan hasta ekstübe edildi. Gözlem amaçlı postoperatif bakım ünitesine alındı. Operasyondan sonra 1 gün yoğun bakımda takip edilen hasta problemsiz bir şekilde taburcu edildi. Tartışma:MPS’li hastaların anestezi açısından preoperatif, perioperatif ve postoperatif dönemde zorlukları ve riskleri vardır. MPS hastalarında preoperatif dönemde iyi bir değerlendirme yapılması gereklidir. Anestezi öncesi değerlendirmede zor entübasyon, zor ventilasyon, kardiyak ve servikal spinal gibi sorunlar değerlendirilir ve gerekli hazırlıkları yapılırsa anestezik riskler oldukça düşer. Hastanın servikal ve trakeolaringeal anatomisi ile altta yatan respiratuar ve kardiyak patofizyolojisi hakkında dikkatli olunmalıdır. Preoperatif olarak başta çocuk nörolojisi ve çocuk kardiyolojisi olmak üzere gerekli bölümlerce konsülte edilmelidir  ADDIN EN.CITE  ADDIN EN.CITE.DATA 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(4) 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Biz hastamızı preoperatif gerekli bölülerle konsulte ederek gerekli hazırlıkları yaptık ve konsültasyon sonucunda verilen tavsiyelere uyduk. Ayrıca göğüs hastalıkları konsültasyonu istenebilir. MPS hastalarında sıklıkla OSAS görülmektedir ve şiddetli OSAS hikayesi olan hastaların anestezi sırasında havayolu acili yaşama ihtimali yüksektir  ADDIN EN.CITE <EndNote><Cite><Author>John</Author><Year>2011</Year><RecNum>11</RecNum><DisplayText>(5)</DisplayText><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="aawxpsrpzwsf9aewp9gv0xw2frwwvr9afwrx" timestamp="1643718173">11</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>John, A.</author><author>Fagondes, S.</author><author>Schwartz, I.</author><author>Azevedo, A. C.</author><author>Barrios, P.</author><author>Dalcin, P.</author><author>Menna-Barreto, S.</author><author>Giugliani, R.</author></authors></contributors><auth-address>Sleep Disorders Center, Pulmonary Service, Hospital de Clínicas de Porto Alegre, Brazil. angelajohn@terra.com.br</auth-address><titles><title>Sleep abnormalities in untreated patients with mucopolysaccharidosis type VI</title><secondary-title>Am J Med Genet A</secondary-title></titles><periodical><full-title>Am J Med Genet A</full-title></periodical><pages>1546-51</pages><volume>155a</volume><number>7</number><edition>2011/06/04</edition><keywords><keyword>Adolescent</keyword><keyword>Child</keyword><keyword>Child, Preschool</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Echocardiography, Doppler</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Hypertension, Pulmonary/etiology</keyword><keyword>Male</keyword><keyword>Mucopolysaccharidosis VI/*complications</keyword><keyword>Polysomnography</keyword><keyword>Prevalence</keyword><keyword>Respiratory Tract Diseases/pathology</keyword><keyword>Sleep Apnea, Obstructive/diagnosis/epidemiology/*etiology</keyword></keywords><dates><year>2011</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1552-4825</isbn><accession-num>21638759</accession-num><urls></urls><electronic-resource-num>10.1002/ajmg.a.33902</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(5).MPS’de görülen spinal ve kraniofasiyal anomaliler nedeniyle zor maske ventilasyonu ve entübasyon beklenebilir. Bizim hastamızda bulunan büyük kafa ve dil, boyunda hareket kısıtlılığı nedeniyle işlem öncesi zor entübasyon şartları hazırlandı. Entübasyon sırasında video laringoskop kullanıldı. Ayrıca her türlü ihtimale karşılık laringeal maske airway ve fleksible laringoskop kullanılmaya hazır bir şekilde bekletildi.Hastalar cerrahi bitiminden sonraki en erken dönemde ekstübe olmalıdır. Bu durum entübasyondan kaynaklanan havayolunda oluşabilecek ödemi azaltmaya ve erken nörolojik değerlendirmeye izin verir ADDIN EN.CITE  ADDIN EN.CITE.DATA 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(4) 3C456E644E6F74653E3C436974653E3C417574686F723E57616C6B65723C2F417574686F723E3C596561723E323031333C2F596561723E3C5265634E756D3E31303C2F5265634E756D3E3C446973706C6179546578743E2834293C2F446973706C6179546578743E3C7265636F72643E3C7265632D6E756D6265723E31303C2F7265632D6E756D6265723E3C666F726569676E2D6B6579733E3C6B6579206170703D22454E222064622D69643D2261617778707372707A777366396165777039677630787732667277777672396166777278222074696D657374616D703D2231363433373138303934223E31303C2F6B65793E3C2F666F726569676E2D6B6579733E3C7265662D74797065206E616D653D224A6F75726E616C2041727469636C65223E31373C2F7265662D747970653E3C636F6E7472696275746F72733E3C617574686F72733E3C617574686F723E57616C6B65722C20522E3C2F617574686F723E3C617574686F723E42656C616E692C204B2E20472E3C2F617574686F723E3C617574686F723E427261756E6C696E2C20452E20412E3C2F617574686F723E3C617574686F723E42727563652C20492E20412E3C2F617574686F723E3C617574686F723E4861636B2C20482E3C2F617574686F723E3C617574686F723E4861726D61747A2C20502E20522E3C2F617574686F723E3C617574686F723E4A6F6E65732C20532E3C2F617574686F723E3C617574686F723E526F77652C20522E3C2F617574686F723E3C617574686F723E536F6C616E6B692C20472E20412E3C2F617574686F723E3C617574686F723E56616C64656D617273736F6E2C20422E3C2F617574686F723E3C2F617574686F72733E3C2F636F6E7472696275746F72733E3C617574682D616464726573733E526F79616C204D616E63686573746572204368696C6472656E2661706F733B7320486F73706974616C2C204F78666F726420526F61642C204D616E636865737465722C20554B2E20526F626572742E57616C6B657240636D66742E6E68732E756B3C2F617574682D616464726573733E3C7469746C65733E3C7469746C653E416E61657374686573696120616E6420616972776179206D616E6167656D656E7420696E206D75636F706F6C797361636368617269646F7369733C2F7469746C653E3C7365636F6E646172792D7469746C653E4A20496E6865726974204D65746162204469733C2F7365636F6E646172792D7469746C653E3C2F7469746C65733E3C706572696F646963616C3E3C66756C6C2D7469746C653E4A20496E6865726974204D65746162204469733C2F66756C6C2D7469746C653E3C2F706572696F646963616C3E3C70616765733E3231312D393C2F70616765733E3C766F6C756D653E33363C2F766F6C756D653E3C6E756D6265723E323C2F6E756D6265723E3C65646974696F6E3E323031322F31322F30313C2F65646974696F6E3E3C6B6579776F7264733E3C6B6579776F72643E416972776179204D616E6167656D656E742F6164766572736520656666656374732F2A6D6574686F64733C2F6B6579776F72643E3C6B6579776F72643E416972776179204F62737472756374696F6E2F2A6574696F6C6F67792F2A746865726170793C2F6B6579776F72643E3C6B6579776F72643E416E65737468657369612F6164766572736520656666656374732F2A6D6574686F64733C2F6B6579776F72643E3C6B6579776F72643E48756D616E733C2F6B6579776F72643E3C6B6579776F72643E4D75636F706F6C797361636368617269646F7365732F2A70687973696F706174686F6C6F67792F2A746865726170793C2F6B6579776F72643E3C6B6579776F72643E5269736B20466163746F72733C2F6B6579776F72643E3C2F6B6579776F7264733E3C64617465733E3C796561723E323031333C2F796561723E3C7075622D64617465733E3C646174653E4D61723C2F646174653E3C2F7075622D64617465733E3C2F64617465733E3C6973626E3E303134312D3839353520285072696E7429262378443B303134312D383935353C2F6973626E3E3C616363657373696F6E2D6E756D3E32333139373130343C2F616363657373696F6E2D6E756D3E3C75726C733E3C2F75726C733E3C637573746F6D323E504D433335393034323220726563656976656420612066656520666F72206C6563747572696E6720617420616E206F7267616E6973656420656475636174696F6E2073796D706F7369756D2066756E6465642062792042696F4D6172696E20506861726D61636575746963616C20496E632E2044722E2042656C616E692068617320616C736F2070617274696369706174656420696E20612073747564792066756E6465642062792042696F6D6172696E2C20496E632E20616E642069732070617274696369706174696E6720696E20737475646965732066756E6465642062792053686972652048756D616E2047656E65746963205468657261706965732C20496E632E2044722E204A6F6E65732069732061207072696E636970616C20696E76657374696761746F72206F6E20737475646965732066756E6465642062792042696F4D6172696E20616E6420726563656976656420686F6E6F726172696120666F7220737065616B696E6720616E6420636F6E73756C74616E637920666565732E2044722E204861726D61747A206861732070726F766964656420636F6E73756C74696E6720736572766963657320746F2042696F4D6172696E20506861726D61636575746963616C20496E632E20616E6420616C736F207265636569766564207265736561726368206772616E74732C2070617274696369706174656420696E2061647669736F727920626F617264732C20616E6420726563656976656420737065616B65727320686F6E6F726172696120616E642074726176656C20737570706F72742E204D722E20536F6C616E6B69206973206120636F6E73756C74616E74206E6575726F73757267656F6E20666F7220746865204269726D696E6768616D204368696C6472656EE280997320486F73706974616C204E485320466F756E646174696F6E20547275737420616E642068617320726563656976656420737065616B6572E280997320686F6E6F72617269756D20616E642074726176656C20737570706F72742066726F6D2042696F4D6172696E2E2044722E204861636B20616E642044722E2056616C64656D617273736F6E2068617665206E6F20636F6E666C69637473206F6620696E7465726573743C2F637573746F6D323E3C656C656374726F6E69632D7265736F757263652D6E756D3E31302E313030372F7331303534352D3031322D393536332D313C2F656C656374726F6E69632D7265736F757263652D6E756D3E3C72656D6F74652D64617461626173652D70726F76696465723E4E4C4D3C2F72656D6F7465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.Ekstübasyon tam olarak uyanmadan, yeterli solumadan, güçlü bir şekilde öksürmeden ve bilinçli hareket etmeden gerçekleştirilmemelidir  ADDIN EN.CITE <EndNote><Cite><Author>Walker</Author><Year>2003</Year><RecNum>12</RecNum><DisplayText>(6)</DisplayText><record><rec-number>12</rec-number><foreign-keys><key app="EN" db-id="aawxpsrpzwsf9aewp9gv0xw2frwwvr9afwrx" timestamp="1643718223">12</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Walker, R. W.</author><author>Colovic, V.</author><author>Robinson, D. N.</author><author>Dearlove, O. R.</author></authors></contributors><auth-address>Department of Anaesthetisia, Royal Manchester Children&apos;s Hospital, Pendlebury, Manchester, UK.</auth-address><titles><title>Postobstructive pulmonary oedema during anaesthesia in children with mucopolysaccharidoses</title><secondary-title>Paediatr Anaesth</secondary-title></titles><periodical><full-title>Paediatr Anaesth</full-title></periodical><pages>441-7</pages><volume>13</volume><number>5</number><edition>2003/06/07</edition><keywords><keyword>Adolescent</keyword><keyword>Airway Obstruction/*complications/diagnostic imaging</keyword><keyword>Anesthesia/*adverse effects</keyword><keyword>Bronchoscopy</keyword><keyword>Child</keyword><keyword>Decompression, Surgical</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Mucopolysaccharidoses/*complications/diagnostic imaging</keyword><keyword>Mucopolysaccharidosis I/complications</keyword><keyword>Mucopolysaccharidosis II/complications</keyword><keyword>Mucopolysaccharidosis VI/complications</keyword><keyword>Pulmonary Edema/diagnostic imaging/*etiology</keyword><keyword>Radiography</keyword><keyword>Spinal Fusion</keyword></keywords><dates><year>2003</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1155-5645 (Print)&#xD;1155-5645</isbn><accession-num>12791120</accession-num><urls></urls><electronic-resource-num>10.1046/j.1460-9592.2003.00969.x</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>(6) Hastamızı mümkün olduğu kadar erken ekstübe etmek amacıyla kas gevşeticinin geri çevirilmesi için sugammadex kullanıldı. Hastamız sorunsuz şekilde ekstübe edildi.Postoperatif apne riski nedeniyle postoperatif bakım ünitesinde dikkatli takip gerekmektedir. Postoperatif dönemde, hastada oluşabilecek komplikasyonlar ve solunum problemleri olabileceği için hastanın yoğun bakıma transferi düşünülmelidir. MPSli hastalarda multisistem tutulumu olması nedeniyle farklı sistemler etkilenebilir. Hem havayolu problemleri hem de sistemik diğer problemler nedeniyle tüm riskler göz önünde bulundurulmalı ve yaşanabilecek tüm bu zorluklar için dikkatli hazırlık yapılmalıdır.Anahtar Kelimeler: Mukopolisakkaridoz, MPS, MPS tip 3 anestezi yönetimi, pediatrik anestezi ADDIN EN.REFLIST 1. Danos O, Heard JM. Mucopolysaccharidosis. Mol Cell Biol Hum Dis Ser. 1995;5:350-67.2. Kliegman R, Stanton B, St. Geme JW, Schor NF, Behrman RE, . Nelson Textbook of Pediatrics. Phialdelphia: Elsevier; 2011. 480-510 p.3. Kamin W. Diagnosis and management of respiratory involvement in Hunter syndrome. Acta Paediatr. 2008;97(457):57-60.4. Walker R, Belani KG, Braunlin EA, Bruce IA, Hack H, Harmatz PR, et al. Anaesthesia and airway management in mucopolysaccharidosis. J Inherit Metab Dis. 2013;36(2):211-9.5. John A, Fagondes S, Schwartz I, Azevedo AC, Barrios P, Dalcin P, et al. Sleep abnormalities in untreated patients with mucopolysaccharidosis type VI. Am J Med Genet A. 2011;155a(7):1546-51.6. Walker RW, Colovic V, Robinson DN, Dearlove OR. Postobstructive pulmonary oedema during anaesthesia in children with mucopolysaccharidoses. Paediatr Anaesth. 2003;13(5):441-7.
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    A new maneuver for classical laryngeal mask airway insertion: Prospective randomized study
    (2022-08-01) Esen A.; Bakan M.; Topuz U.; Ertaş Dursun Z.; Karaaslan K.; ESEN, ASIM; KARAASLAN, KAZıM
    Background/Aim: Laryngeal mask airway (LMA) has been frequently used for airway management. But the satisfaction of the insertion and trauma at insertion remain problems. We present a new insertion maneuver for classical LMA (cLMA) with a partially inflated cuff and examine its success and complication rate.Methods: In 4 months, 158 patients who were classified as ASA I–III and older than 18 years old and were planned for LMA were included in this study consecutively (according to the study design, one patient was excluded during the study). Emergency cases, patients with any contraindications with LMA, patients who were expected to undergo surgery for more than 2 h, patients with preoperative respiratory tract infection or sore throat, patients undergoing oral or nasal surgery, and patients with aspirated oropharyngeal secretions after removal of LMA was excluded from the study. Age, gender, height, weight, ASA scores, comorbidities, and the duration of anesthesia and surgery of the patients were recorded. One-hundred-fifty-seven consecutive patients were randomized into two groups by a coin toss [control group (group C) and study group (group S)]. The groups were compared in terms of LMA insertion success, the number of insertion attempts, the presence of blood on the LMA or in secretions, and postoperative sore throat. Classical Laryngeal Mask Airway was inserted with Brain’s standard technique in group C and with the new technique in group S. In the new technique, the head and neck of the patient were supported in a straight position, the mouth was opened, cLMA was held with a dominant hand from the tube part and inserted until the tip touches to the oropharynx. The index finger of the non-dominant hand was inserted into the mouth to pass by the cLMA and reach the tip of the cLMA. The tip of cLMA was directed to the caudal by the index finger. Then, cLMA was inserted by the guidance of the index finger until it reached the triangular base of the oropharynx.Results: There was no statistically significant difference in terms of demographic data and placement success; placement success was better in the study group (100% versus 98.6% and P = 0.45). Similarly, the count of attempts was better in the study group. The mean attempt number was 1.11 in group S and 1.28 in group C (P = 0.02). Also, blood on LMA was seen to be more common in group C (P = 0.04). There were no statistical differences in sore throat, but it was less seen in group S.Conclusion: The new maneuver was better than the standard technique and easy to use in daily practice.Keywords: Airway management, Laryngeal mask airway, Complications
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    Pediyatrik Nazotrakeal Entübasyonda Nazofarenks Geçişi için Kılavuz Tel Kullanımı: Prospekif Randomize Çalışma
    (2023-11-05) Esen A.; Kangarlı N.; ESEN, ASIM; KANGARLI, NIGAR
    Pediyatrik Nazotrakeal Entübasyonda Nazofarenks Geçişi için Kılavuz Tel Kullanımı: Prospektif Randomize ÇalışmaGiriş: Genel anestezi altında yapılan pedodontik uygulamalarda nazotrakeal entübasyon (NTE) sıklıkla kullanılır. Konvansiyonel yolla yapılan NTE’de nazofarengeal travma ve kanama sık görülmektedir (1,2). Bu çalışmada, endotrakeal tüp (ETT) içine kılavuz tel konularak tüpün ucuna açı-kavis verilmesinin, nazofarengeal travma ve kanama üzerine etkisini araştırmayı amaçladık. Materyal/Metod: Çalışmaya 2-12 yaş arası 90 pedodonti hastası alındı ve iki gruba ayrıldı. Kontrol grubunda (GrupK) NTE konvansiyonel yolla yapıldı. Çalışma grubunda (GrupÇ) ise ETT içine bir kılavuz tel yerleştirildi ve tüpün distal ucuna (2,5-3 cm proksimalden) 100-120 derece açı verildi (hokey sopası şekli). ETT, ucu yüze dik olacak şekilde buruna sokuldu. Tüpün açılı kısmı burun deliklerinin girişini geçtikten sonra tüpün ucuna verilen kavise uygun şekilde ilerletildi. Bu esnada, ETT içine yerleştirilen kılavuz tel sayesinde ETT bir bütün olarak hastanın baş tarafına doğru \"yatırıldı\" ve eş zamanlı olarak ilerletildi. Bu sayede ETT ucunun nazofarenks arka duvarına temas etmeden kaudale yönlenmesi hedeflendi. Tüp ucu orofarenkse ulaşınca kılavuz tel çıkartıldı ve entübasyonun geri kalan kısmı konvansiyonel yöntemde olduğu gibi tamamlandı.Sonuçlar: Gruplar istatistiki olarak benzerdi (Tablo 1-2). Kanama kontrolü entübasyonun 1. ve 5. dakikalarında, hastanın grubunu bilmeyen bir anestezist tarafından yapıldı. Kanama; Yok, hafif kanama (tüpe bulaşma tarzında) ve şiddetli kanama (orofarenksteki tüpün etrafında kan birikintisi) olarak üç kategoride değerlendirildi. Tüm gruplarda grupÇ grupK’ya göre daha iyiydi (Tablo 3-4) (1. dk: kanama yok Ç: %84,4, K: %46,7; hafif kanama Ç:%15,6, K: 31,1; şiddetli kanama Ç: %0,0, K: %22,2. 5. dk. Kanama yok Ç: %82,2, K: %28,9, hafif kanama Ç:15,6, K: 40,0, şiddetli kanama Ç: 2,2, K: 31,1. 1. dk ve 5. dk p< 0.001)Tartışma: Sonuçlarımıza göre;1- Kılavuz tel kullanılarak yapılan NTE, konvansiyonel yönteme göre belirgin şekilde daha az nazofarengeal kanamaya neden olmuştur. 2- Test edilen yöntemin burun iç duvarlarındaki travmaya engel olması beklenmez. Bu nedenle, çalışmamıza göre konvansiyonel NTE esnasındaki kanamanın çoğunlukla nazofarenks arka duvar travmasına bağlı olduğu da düşünülebilir.
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    The evaluation of brain natriuretic peptide changes and difficult airway predictors during perioperative period of pregnancy
    (2016-02-01) Basaranoglu, GÖKÇEN; UMUTOGLU, T.; BAKAN, M.; ESEN, ASIM; ATES, SEDA; BACAKSIZ, AHMET; SALIHOGLU, Z.; BAŞARANOĞLU, GÖKÇEN; ESEN, ASIM; ATEŞ, SEDA; BACAKSIZ, AHMET
    Aim Airway changes, difficult ventilation, and intubation are the leading causes of morbidity and mortality in pregnancy, but no prospective study has evaluated the relationship between airway changes and brain natriuretic peptide (BNP) before and after cesarean section operations. The purpose of this study was to evaluate the relationship between BNP and airway changes in women undergoing delivery and during the postoperative period.
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    Genel anestezi altında diş tedavisi planlanan akçaağaç şurubu idrar hastalığı olan hastada anestezik yaklaşım
    (2022-02-13) Esen A.; Uysal H.; Sümer İ.; ESEN, ASIM; UYSAL, HARUN; SÜMER, İSMAİL
    Genel anestezi altında diş tedavisi planlanan akçaağaç şurubu idrar hastalığı olan hastada anestezik yaklaşımDr. Öğr. Üyesi Asım ESENBezmialem Vakıf Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon AD, esen1122@hotmail.com, ORCİD No: 0000-0001-7222-7499, GSM: +90 533 521 94 55Dr. Öğr. Üyesi Harun UYSALBezmialem Vakıf Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon AD, drharunuysal@hotmail.com, ORCİD No: 0000-0003-0426-8525, GSM: +90 506 343 34 94Dr. Öğr. Üyesi İsmail SümerBezmialem Vakıf Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon AD, isosumer@gmail.com, ORCİD No: 0000-0002-0133-0218 GSM: +90 533 220 15 76GirişAkçaağaç şurubu idrar hastalığı (MSUD) otozomal resesif, doğumsal ve sıklığı yaklaşık 1/185000 olan bir metabolik hastalıktır. Hastalığın sebebi dokularda yaygın olarak bulunan ve dallı zincirli aminoasitlerin oksidatif dekarboksilasyonundan sorumlu bir enzimin eksikliğidir. Bu eksiklik, dallı zincirli aminoasitler olan valin, lösin ve izolösinin kanda ve idrarda birikmesine neden olur. Hastalığın beş ayrı klinik fenotipi vardır. Klinik gidiş, fenotipe ve tedaviye başlanma zamanına bağlı olarak değişir.OlguHastamız 5 yaşında, 22 kg, 96 cm ve anne-babası akraba olan erkek çocuktu. Genel anestezi altında diş tedavisi planlanan hastamızda hafif bir motor-mental ve büyüme-gelişme geriliği mevcuttu. Tedavisine erken dönemde (postpartum onbeşinci gün) başlanan hasta valin-lösin replasman tedavisi, profilaktik antiepileptik ve multivitamin ilaçları almaktaydı. Preoperatif testlerinde önemli bir anormallik yoktu. Çocuk metabolizması ünitesine danışılan hastanın preoperatif açlık döneminde alması için total parenteral nutrisyon (TPN) hazırlandı. 0,5 mg/kg midazolam ile premedike edilen hasta ameliyathaneye alındı ve intravenöz anestezi indüksiyonu sonrası nazotrakeal entübasyon uygulandı. İnhalasyon anestezisi ile idame sağlandı. Ameliyat ve anestezi süreci olaysızdı. Ameliyat esnasında ve derlenme ünitesi sürecinde aralıklı kan şekeri takibi yapıldı. Derlenme ünitesinde yaklaşık yarım saat takip edildi ve her hangi bir problem yaşanmadı. Postoperatif dönemde oral beslenme başlanana kadar TPN nin devam edilmesi önerisiyle hasta servise verildi.Tartışma ve SonuçMSUD hastalarının preoperatif dönemde detaylı olarak değerlendirilmesi gerekir. İyi kontrol edilmiş bir süreçle ameliyata hazırlanan hastaların peroperatif dönemi genellikle sıkıntısız seyretme eğilimindedir. Ancak kontrol altında bir hasta değilse, nörokognitif gelişme geriliği, kasılma epizodları, epileptik nöbetler, hipoglisemi atakları, asidoz, dehidratasyon, beyin ödemi ve kafa içi basınç artışı gibi morbidite ve mortalite ihtimali yüksek problemler görülebilir. Bu nedenle peroperatif dönem için özellikle ilaçların düzenli alınıyor olması, sıvı replasmanı, beslenmeye dikkat ve yakın kan şekeri takibi önemlidir.Anahtar kelimelerAkçaağaç şurubu idrar hastalığı, genel anestezi, havayolu yönetimiAnesthetic approach to the patient with maple syrup urine disease which is planned for dental treatment under general anesthesiaBackroundMaple syrup urine disease (MSUD) is an autosomal recessive congenital metabolic disease. The frequency of disease is approximately 1/185000. The cause of the disease is the deficiency of an enzyme located in the inner membrane of the mitochondria, which is responsible for the oxidative decarboxylation of branched-chain amino acids. This enzyme is found in many tissues such as skeletal muscles, liver, brain and kidney. Deficiency of this enzyme causes the branched-chain amino acids valine, leucine and isoleucine to accumulate in the blood and urine. The disease has five different clinical phenotypes. The clinical course varies depending on the phenotype and the time of initiation of treatment.CaseOur patient is a 5-year-old boy, 22 kg, 96 cm, and whose parents are related. Our patient, who was scheduled for dental treatment under general anesthesia, had mild motor-mental and growth retardation. The patient, whose treatment was started in the early period (postpartum fifteenth day), was taking valine-leucine replacement therapy, some prophylactic antiepileptic drugs and multivitamin drugs. There was no significant abnormality in the preoperative laboratory tests. Total parenteral nutrition (TPN) solution was prepared for the patient to take during the preoperative fasting period, who was consulted with the pediatric metabolism unit. The patient, who was premedicated with 0.5 mg/kg midazolam, was taken into the operating room. After induction of intravenous anesthesia, nasotracheal intubation was performed. Maintenance of anesthesia was provided with inhalation anesthesia. Surgery and anesthesia were uneventful. Intermittent blood glucose monitoring was performed during the surgery and during the recovery unit. He was followed in the recovery unit for about half an hour and no problems were encountered. In the postoperative period, the patient was transferred to the ward with the recommendation to continue TPN until oral feeding was started.Discussion and ConclusionMSUD patients should be evaluated in detail in the preoperative period. The perioperative period of patients who are prepared for surgery with a well-controlled process generally tends to be uneventful. However, if the patient is not under control, problems such as neurocognitive disorders, convulsive episodes, epileptic seizures, hypoglycemia attacks, acidosis, dehydration, brain edema and increased intracranial pressure may be seen with a high probability of morbidity and mortality. For this reason, it is important to take medications regularly, fluid replacement, attention to nutrition and close blood sugar monitoring for the peroperative period.Keywords Maple syrup urine disease, general anesthesia, airway management
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    Use of a Ketamine-Propofol Combination During Sedation and Analgesia
    (2015-03-01) Basaranoglu, GÖKÇEN; Esen, ASIM; BAKAN, Mefkur; TOPUZ, Ufuk; IDIN, Kadir; UMUTOGLU, Tarik; BAŞARANOĞLU, GÖKÇEN; ESEN, ASIM
    Aim: The aim of this study was to evaluate 1: 1 mixture of ketamine and propofol for sedative/analgesic efficacy, patient comfort and postoperative complications.
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    Publication
    Türkiye’de doğumsal kalp hastalıkları cerrahisinin bugünü ve yarını
    (2012-01-01T00:00:00Z) TÜRKÖZ, AYDA; KARAASLAN, KAZİM; YEŞİLTAŞ, SERDAR; ESEN, ASIM; DAŞKAYA, HAYRETTİN; ÇALIM, MUHİTTİN; TÜRKÖZ, AYDA; KARAASLAN, KAZıM; ESEN, ASIM; ÇALIM, MUHITTIN