Abstract Aim; Coronavirus disease 2019 (COVID-19) has led to a dramatic increase in critically ill patients requiring prolonged mechanical ventilation. Many of these patients require tracheostomies due to prolonged intubation times, respiratory failure, and the need for prolonged ventilatory support. Material and Method; A retrospective analysis was performed on critically ill COVID- 19 patients who were admitted to our ICU and required prolonged mechanical ventilation. Our primery outcome is presenting our experience for performing tracheostomy in COVID-19 patients. Ultrasound guided percutaneous tracheostomy was performed at the bedside in all patients. Results; All percutaneous tracheostomies were performed successfully without complications. The tracheostomy procedure was performed on an average of 14 days after intubation. The mean age of the patients was 71 years, and most had underlying comorbidities such as hypertension, diabetes mellitus, and obesity. Conclusion; Our experience with ultrasound-guided percutaneous tracheostomy in 17 COVİD 19 patients demonstrated that this method is a safe and effective approach in critically ill patients.

Aim: There is currently no pharmacotherapy with for the treatment of COVID-19. We aimed to investigate the effects of early and high-dose vitamin C (VC) therapy in hospitalized patients with COVID-19.Materials and Methods: We included patients (n=139) who received high-dose VC supplement to the standard treatment protocol into group 1 (n=58), and only those who received a standard treatment protocol into group 2 (n=81). The patients' requirement for supplemental oxygen therapy, requirement for intensive care treatment and survival rates was investigated retrospectively. Furthermore, the changes in white blood cell, C-reactive protein (CRP), procalcitonin, D-Dimer, renal function tests, ferritin, and interleukin 6 values during hospitalization were evaluated.Results: When the groups were compared in terms of clinical data, there was no significant difference in terms of the patients requiring supplemental oxygen therapy (p=0.808), requiring intensive care (p=0.662), and survival rates (p=0.185). However, a significant difference was observed between the groups in terms of changes in renal function tests, and CRP values (p<0.05).Conclusion: In the present study, early administration of high-dose VC to patients with COVID-19 has a reducing effect on the impaired kidney functions. Therefore, we recommend the use of VC as an early supplemental therapy in patients with COVID-19.

OBJECTIVEAlthough many studies reported prognostic factors proceeding to severity of COVID-19 patients, in none of the article a prediction scoring model has been proposed. In this article a new prediction tool is presented in combination of Turkish experience during pandemic.MATERIALS AND METHODSLaboratory and clinical data of 397 over 798 confirmed COVID-19 patients from Gülhane Training and Research Hospital electronic medical record system were included into this retrospective cohort study between the dates of 23 March to 18 May 2020. Patient demographics, peripheral venous blood parameters, symptoms at admission, in hospital mortality data were collected. Non-survivor and survivor patients were compared to find out a prediction scoring model for mortality.RESULTSThere was 34 [8.56% (95% CI:0.06-0.11)] mortality during study period. Mean age of patients was 57.1±16.7 years. Older age, comorbid diseases, symptoms, such as fever, dyspnea, fatigue and gastrointestinal and WBC, neutrophil, lymphocyte count, C-reactive protein, neutrophil-to-lymphocyte ratio of patients in non-survivors were significantly higher. Univariate analysis demonstrated that OR for prognostic nutritional index (PNI) tertile 1 was 18.57 (95% CI: 4.39-78.65, p<0.05) compared to tertile 2. Performance statistics of prediction scoring method showed 98% positive predictive value for criteria 1.CONCLUSIONSIt is crucial to constitute prognostic clinical and laboratory parameters for faster delineation of patients who are prone to worse prognosis. Suggested prediction scoring method may guide healthcare professional to discriminate severe COVID-19 patients and provide prompt intensive therapies which is highly important due to rapid progression leading to mortality.

Objective: CRBD is a condition that occurs commonly in postanesthetic patients who undergo intraoperative urinary catheterization. The aim of this study is to investigate and compare the effects of ketamine and tramadol on severity and incidence of CRBD. The patients that underwent elective percutaneous nephrolithotomy operations under general anesthesia were monitorized perioperatively.Material and Method: After induction of anaesthesia Foley urinary catheters were introduced. 20 minutes before extubation placebo (0.9% NaCl), 250 µg/kg ketamine IV and 1.5 mg/kg tramadol IV were administered to the patients in the group S, K and T, respectively. VAS (Visual Analogue Scale), arterial blood pressure, heart rate, saturation of arterial oxygen are assessed and recorded at 5, 10, 15 and 30 minutes postoperatively. Severity of CRBD and incidence of nausea are assessed and recorded by an observer who was blind to the study at 0, 1, 4 and 6 hours postoperatively. If VAS 3, 0.5-1 mg/kg meperidine IV were administered to the patients as an urgent analgesia. Patients with 3rd degree nausea and vomiting were given anti-emetic and 4 mg iv ondansetron.Results: In conclusion we have found that ketamine and tramadol which were given 20 minutes before extubation reduced the VAS and CRBD scores, and analgesic need in tramadol group was lesser than the other two groups.Conclusion: We think that in patients who undergo elective percutaneous nefroliotomy under general anesthesia tramadol is a safe and effective method which reduces severity and incidence of postoperative CRBD.

Amac: Kateter kaynakli mesane rahatsizligi (KKMR) post anestezik hastalarda yaygin gorulen bir durumdur. Bu calismanin amaci tramadolun ve ketaminin KKMR bulgusunun azaltilmasindaki etkinliklerinin karsilastirilmasidir. Gerec ve Yontem: Calismamiz Uroloji ameliyathanesinde genel anestezi altinda peruktan nefrolitotomi ameliyati olan 90 hasta ile yapilmistir. Hastalara intraoperatif foley sonda takildi. Uyandirma isleminden 20 dk once grup K hastaya ketamin (250 ugr/kg) grup T hastaya tramadol (1,5 mg/kg) ve grup S hastaya plasebo (%0,9 sf) ilac IV uygulandi. Hastalarin post op 5., 10., 15., 30. dk'da VAS degeri, hemodinamik parametreleri kaydedildi. VAS’i 3 ve uzeri olan uc gruptaki hastalara, acil analjezi icin meperidin 0.5-1 mg/kg IV meperidin verildi. KKMR nin seviyesi ve bulanti bagimsiz bir gozlemci tarafindan 0., 1., 4., 6. saatlerde ayrica degerlendirildi. 3. derece bulanti - kusmasi olan hastalara anti-emetik olarak, 4mg iv ondansetron verildi. Bulgular: Ekstubasyondan 20 dakika once verilen, ketamin ve tramadolun, VAS degerlerini azalttigi, KKMR skorlarini dusurdugu, ek analjezik gereksiniminin tramadol grubunda daha az oldugu sonuclarina ulasildi. Sonuc: Biz genel anestezi altinda elektif perkutan nefrolitotomi operasyonu uygulanan hastalarda, tramadolun, postoperatif KKMR siddeti ve insidansini azaltmada guvenli ve etkili bir yontem olabilecegi kanisindayiz.

Long-term central venous catheters are important in patients with cancer and other debilitating diseases. Although there are early and late complications, with an overall rate of approximately 13%, migration of a central venous catheter is rare. In this case report, we report migration of a Hickman’s catheter into the internal jugular vein, 25 days after satisfactory initial placement. The Hickman’s catheter was then removed and repositioned properly under scopy using guidewire. Periodic monitoring of catheter position with chest radiography can enable detection of migration early, interventional repositioning before thrombosis develops, and treatment to be made appropriately.

Introduction . Postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy operations still continue to be a serious problem. Intravenous fluid administration has been shown to reduce PONV. Some patients have higher risk for PONV described by APFEL score. In this study, our aim was to determine the effects of preoperative intravenous hydration on postoperative nausea and vomiting in high Apfel scored patients undergoing laparoscopic cholecystectomy surgery. Patients and Methods . This study is performed with 50 female patients who had APFEL score 3-4 after ethics committee approval and informed consent was taken from patients. The patients were divided into 2 groups: group 1 (P 1 ): propofol + preoperative hydration and group 2 (P 2 ): propofol + no preoperative hydration. Results . When the total nausea VAS scores of groups P 1 and P 2 to which hydration was given or not given were compared, a statistically significant difference was detected at 8th and 12th hours (P=0.001andP=0.041). It was observed that in group P 1 , which was given hydration, the nausea VAS score was lower. When the total number of patients who had nausea and vomiting in P 1 and P 2 , more patients suffered nausea in P 2 group. Discussion . Preoperative hydration may be effective in high Apfel scored patients to prevent postoperative nausea.

SUMMARY Objective: The effectiveness of remifentanil infusion and fentanyl bolus provided by patient-controlled analgesia on postoperative pain and recovery of patients undergoing pre-planned fast-track cardiac surgery was studied. Material and Methods: Anaesthesic combination of sevofloran and remifentanil were applied to 42, ASA II group patients undergoing fast-track coronary artery bypass graft surgery. Patients were divided into two groups. In Group 1 (remifentanil group), 0.1 µg kg -1 min -1 remifentanil infusion was given postoperatively by patient-controlled analgesia device. In Group 2, fentanyl was administered at 10 µg kg -1 loading dose 5 minutes before the end of surgery. After fentanyl administration, fentanyl bolus protocol was started to be applied at 0.1 µg kg -1 bolus dose with 8 minutes lockout time. Pain scores, sedation levels and additional analgesic requirements were recorded for the first 4 hours at every 15 minutes and then at 12., and 24. hours postoperatively. Results: There was no difference between groups as for analgesic effectiveness. The sedation levels were lower postoperatively during the first two hours in Group 1. After two hours, sedation levels were similar between the two groups. Conclusion: Remifentanil can be used at analgesic doses during the recovery period of patients undergoing fast-track cardiac surgery.

Background: The aim of this prospective, randomized, single-blinded study was to compare the effects of a carbohydrate drink 400 mL given 2 h before the surgery with preoperative overnight fasting on the gastric pH and residual volume, postoperative nausea and vomiting (PONV) and antiemetic consumption in patients undergoing laparoscopic cholecystectomy. Materials And Methods: Forty American Society of Anesthesiologists physical status I-II patients who underwent elective laparoscopic cholecystectomy. Randomized, prospective, controlled study, Gulhane Medical Faculty and Guven Hospital Department of Anesthesiology and Reanimation. Patients were randomly assigned into two groups: Pre-operative carbohydrate drink group (group C, n = 20) and preoperative fasting group (group F, n = 20). Group C was given a 400 mL carbohydrate drink 2 h before to the surgery. The patients of group F were fasted 8 h before the surgery. Both groups were operated under general anesthesia with volatile anesthetics. Results: Hemodynamic parameters, demographic data, gastric acidity and residual volumes were similar for both groups. No complications were observed. PONV and antiemetic consumption was lower in group C compared to group F (P = 0.001). Patient's satisfaction was higher in group C (P < 0.001). Conclusion: This study showed that pre-operative carbohydrate drink may be used safely and also improves patient's satisfaction and comfort in patients undergoing laparoscopic cholecystectomy.

Atelectasis is a commonly seen complication during the post-operative period in intensive care units. The treatment of atelectasis depends on the underlying cause. We aimed to share our experience on the treatment of right total atelectasis in our intensive care unit applied with the help of the endobronchial blocker.

Pregnancy carries an increased risk for mother and the fetus in patients with cardiac disease. In this case we represent a woman with gestational age of 16 weeks, who was resuscitated and underwent double valve replacement with longer cardiopulmonary bypass times (112 minutes of cross clamping and 133 minutes of perfusion time) due to infective endocarditis and decompensed heart failure. After the surgery at 38th gestational weeks, she gave birth uneventfully to a healthy child whose Apgar score was 9 at first and fifth minutes of the delivery. Heart surgery during pregnancy can be performed with acceptable maternal and fetal mortality rates. These rates may even be lower if strict protocols performed during every step of surgery and after.

STUDY OBJECTIVE:To quantify and compare the effects of conventional volume-controlled ventilation (VCV) with the alternative mode, pressure-controlled ventilation (PCV), on respiratory mechanics and noninvasive hemodynamic parameters in patients undergoing laparoscopic gynecologic surgery.DESIGN:Randomized controlled trial (Canadian Task Force classification I).SETTING:Respiratory mechanics and hemodynamic parameters were recorded for each patient at time T1, 10 minutes after induction, in the supine position; T2, 15 minutes after pneumoperitoneum, in the Trendelenburg position; and T3, 10 minutes after pneumoperitoneum withdrawal, in the supine position.PATIENTS:Sixty women, aged 20 to 50 years, undergoing laparoscopic gynecologic surgery, with American Society of Anesthesiologists classes I and II disease.INTERVENTIONS:Patients were randomly allocated to 1 of 2 groups. In the VCV group (n = 30), ventilation mode was maintained, whereas in the PCV group (n = 30), ventilation mode was changed to PVC.MEASUREMENTS AND MAIN RESULTS:Both groups were comparable insofar as patient characteristics, operating time, pneumoperitoneum time, anesthesia time, and mean operative time. VCV was associated with a significant increase in peak airway pressure, plateau pressure, and airway resistance at T2 (p < .05). Compliance was significantly higher in the PCV group at T2 (p < .05). No other statistically significant differences were found between the groups.CONCLUSIONS:Both VCV and PCV seem to be equally suited for use in patients undergoing laparoscopic gynecologic surgery. However, lower peak airway pressure, plateau pressure, and airway resistance, and higher compliance are observed with PCV in laparoscopic gynecologic surgery.

Pain management during burn dressing changes is a critical part of treatment in acute burn injuries. Although several treatment options have been suggested, it is still a challenge in a clinical setting. This study is aimed at finding out an ideal analgesic, sedative and/or anxiolytic combination that would minimise the unwanted effects of ketamine. A total of 24 patients, with burns up to 20-50% of total body surface area (TBSA), were included in the study and randomly divided into three groups. In group I, 2 mg kg(-1) ketamine was administered. In group II, 1 mg kg(-1) tramadol was administered and 30 min later, 1 microg kg(-1) dexmedetomidine and 2 mg kg(-1) ketamine was administered. In group III, 1 mg kg(-1) tramadol was applied and 30 min later, 0.05 mg kg(-1) midazolam and 2 mg kg(-1) ketamine was administered. The evaluation was performed with cardiopulmonary monitoring, sedation and visual analogue pain scores and overall patient satisfaction. Any adverse effects of ketamine were recorded. The results showed that group II had better outcomes with respect to pain management during dressing changes. As a conclusion, the use of the combination of ketamine, tramadol and dexmedetomidine was found to be a good treatment option for the prevention of the procedural pain suffered by adult patients during dressing changes.

Background Intestinal ischemia/reperfusion (IR) induces a systemic inflammatory response and releases harmful substances that may affect the function and integrity of distant organs such as lung, liver, and kidney. We conducted this study to find out if proanthocyanidins (PA) has protective effects against mesenteric IR injury and mesenteric IR-induced intestinal and distant organ injury. Materials and methods Thirty-two Sprague-Dawley rats were divided into four groups: control, control + PA, IR, IR + PA. The IR and IR + PA groups were subjected to mesenteric arterial ischemia for 60 min and reperfusion for 6 h. The Control + PA and IR + PA groups were administered PA (100 mg/kg/day via oral gavage) for 7 days prior to injury insult. We collected ileal and distant organ tissues, such as pulmonary, hepatic, and kidney specimens to measure tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and nitrite plus nitrate (NO x ), and we then evaluated histological changes. Results In the IR group, significant increases in MDA and NO x levels and significant increases in SOD and GPx activities of intestine, liver, kidney, and lung were observed. The MDA and NO x levels were significantly lower, as were the SOD and GPx activities in the IR + PA group than that in the IR group. Although the intestine and distant organs damage scores were significantly higher in the IR group, these injuries were prevented by PA in the IR + PA group. Conclusions This study demonstrates that PA has a significant effect in the protection of the intestine and the remote organs against mesenteric IR injury.

Objective: To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel (HS) and classical methods.Methods: Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS (n=22), closed HS (n=22), Miligan Morgan (n=22), and Ferguson (n=21) hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time.Results: Bleeding volume was significantly lower in Groups I-II (p<0.001). Operation time was significantly shorter in Group I (p<0.001). Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III (p<0.001) compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III (p<0.004). Visual Analogue Scale results were similar in Groups II and IV Analgesic consumption in Groups I-III was significantly lower than Groups II-IV (p<0.001). Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III (p<0.007) and similar in closed hemorrhoidectomy group.Conclusion: The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain.