The aim of this study was to evaluate the analgesic efficacy of intravenous PCA using tramadol in... more The aim of this study was to evaluate the analgesic efficacy of intravenous PCA using tramadol in patients, undergoing supratentorial tumor resection with craniotomy. Material and Method: One hundred and fifty patients with ASA I-II between 18 and 70 years of age scheduled for an elective supratentorial craniotomy for tumor resection, were assigned to receive standardized general anesthesia. Postoperative pain was assessed at standard time intervals using a visual analogue scale (VAS) score. When the VAS score was >3, 1 to 1.5 mg/kg of tramadol was administered intravenously and PCA using tramadol was started. For 48 h postoperatively, the VAS, Glasgow coma, sedation, comfort, and nausea and vomiting scores were assessed. Results: During the first 48 hours, 46% of the patients needed analgesic therapy and PCA with tramadol was adequate for these patients. Most patients needed analgesic drugs at 2 hours and their mean analgesic usage was higher at that point than at other periods in the first 2 h (p<0.05). Conclusion: PCA with tramadol can be used effectively for postoperative pain management after craniotomy.
OBJECTIVE The objective of this study was to describe the distribution pattern of cerebellar hemi... more OBJECTIVE The objective of this study was to describe the distribution pattern of cerebellar hemispheric tentorial bridging (CHTB) veins on the tentorial surface in a case series of perimedian or paramedian supracerebellar approaches and to describe a novel technique to preserve these veins. METHODS A series of 141 patients with various pathological processes in different locations was operated on via perimedian or paramedian supracerebellar approaches by the senior author from July 2006 through October 2022 and was retrospectively evaluated. During surgery, the number and locations of all CHTB veins were recorded to establish a distribution map on the tentorial surface, divided into nine zones. Patients were classified into four groups according to the surgical technique used to manage CHTB veins: 1) group 1 consisted of CHTB veins preserved without intervention during surgery or no CHTB veins found in the surgical route; 2) group 2 included CHTB veins coagulated during surgery; 3)...
Journal of Anesthesiology and Reanimation Specialists’ Society, 2020
The virus pandemic called Covid-19 pandemic, has spread from Wuhan city of People's Republic of C... more The virus pandemic called Covid-19 pandemic, has spread from Wuhan city of People's Republic of China to the whole world in December 2019. It poses a risk to healthcare professionals due to patients and asymptomatic cases carrying the disease. In particular, operating theaters are among the most risky work areas in terms of aerosol forming processes and possible contact. For this reason, the establishment of perioperative operation protocols conveys importance. In this review; our "preoperative patient preparation and operating room operation protocols" including preoperative patient preparation, operating room organization and personal protection equipment which have particular importance are presented. Method: For this purpose, existing protocols and literature scanning have been made and the protocol created in the light of current information includes 3 subtitles as preoperative patient preparation, regulation of operating room procedures, and operating room cleaning at the end of the operation. Results: The protocol created was being used between March 15, and May 10, 2020. When the perioperative management is meticulously implemented in line with our protocols created in accordance with the internal functioning of our institution, it has been observed that the surgical process does not fail, besides safety of patients and employees may be reinforced. In the light of clinical protocols, COVID-19 suspected-infected patients can be identified in the preoperative period, and perioperative risks can be reduced and the safety of the patient, healthcare professionals and other patients can be increased.
Lesch-Nyhan disease is a rare X-linked recessive genetic disorder caused by a deficiency of hypox... more Lesch-Nyhan disease is a rare X-linked recessive genetic disorder caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase enzyme. The patients with Lesch-Nyhan Syndrome have several problems such as positioning and difficult intravenous cannulation because of spasticitiy. Also these patients have risk for bradycardia, pulmonary aspiration, convulsion and sudden death. Anesthetic implications of the patients with LeschNyhan Syndrome are not well described. Here we report our anesthesia experience in a 4 years-old child with Lesch-Nyhan syndrome, who underwent cataract surgery. Patients with Lesch-Nyhan syndrome should be carefully evaluated in the preoperative period especially to determine the difficulties in venous access and positioning. These patients should be closely monitored for the potential of pulmonary aspiration, and sudden death postoperatively.
OBJECTIVEThe object of this study was to present the surgical results of a large, single-surgeon ... more OBJECTIVEThe object of this study was to present the surgical results of a large, single-surgeon consecutive series of patients who had undergone transcisternal (TCi) or transcallosal-transventricular (TCTV) endoscope-assisted microsurgery for thalamic lesions.METHODSThis is a retrospective study of a consecutive series of patients harboring thalamic lesions and undergoing surgery at one institution between February 2007 and August 2019. All surgical and patient-related data were prospectively collected. Depending on the relationship between the lesion and the surgically accessible thalamic surfaces (lateral ventricle, velar, cisternal, and third ventricle), one of the following surgical TCi or TCTV approaches was chosen: anterior interhemispheric transcallosal (AIT), posterior interhemispheric transtentorial subsplenial (PITS), perimedian supracerebellar transtentorial (PeST), or perimedian contralateral supracerebellar suprapineal (PeCSS). Since January 2018, intraoperative MRI ha...
Objective We planned a cross-sectional analysis to determine the frequency and severity of metabo... more Objective We planned a cross-sectional analysis to determine the frequency and severity of metabolic acidosis in patients taking topiramate while awaiting craniotomy. Methods Eighty patients (18 – 65 years) taking topiramate to control seizures while awaiting elective craniotomy were enrolled. Any signs of metabolic acidosis or topiramate-related side effects were investigated. Blood chemistry levels and arterial blood gases, including lactate, were obtained. The severity of metabolic acidosis was defined according to base excess levels as mild or moderate. Results Blood gas analysis showed that 71% ( n = 57) of patients had metabolic acidosis. The frequency of moderate metabolic acidosis was 56% ( n = 45), while that of mild metabolic acidosis was 15% ( n = 12). A high respiratory rate was reported in only 10% of moderately acidotic patients. Conclusions In patients receiving topiramate, baseline blood gas analysis should be performed preoperatively to determine the presence and se...
Method: Diz artroskopisi geçirecek 40 hasta, 2 mL %2 prilokain ile spinal ya da 15-20 mL %2 prilo... more Method: Diz artroskopisi geçirecek 40 hasta, 2 mL %2 prilokain ile spinal ya da 15-20 mL %2 prilokain ile epidural anestezi yapılacak şekilde randomize olarak 2 gruba ayrıldı. Hastaların maksimum duyu bloğu seviyeleri, motor ve duyu bloğunun geri dönüş süreleri, ayağa ...
Gereç ve Yöntem: Elektif supratentoriyal kraniyotomi operasyonu planlanan, ASA I-II grubundan, 18... more Gereç ve Yöntem: Elektif supratentoriyal kraniyotomi operasyonu planlanan, ASA I-II grubundan, 18-70 yaş arasında 150 hasta çalışmaya dahil edilerek, propofol ve remifentanil ile standart genel anestezi uygulandı. Bupivakain ve epinefrin ile çivili başlık noktalarına ...
Amaç: Yaşlı hastalarda sık görülen travmatik kalça kırığının major tedavisi total kalça protezidi... more Amaç: Yaşlı hastalarda sık görülen travmatik kalça kırığının major tedavisi total kalça protezidir. Ancak bu girişim venöz tromboemboli gibi belirgin postoperatif komplikasyonlara neden olabilir. Bu çalışmada travmatik kalça kırığı nedeniyle total kalça protezi operasyonu ...
Object The exploration of lesions in the mediobasal temporal region (MTR) has challenged generati... more Object The exploration of lesions in the mediobasal temporal region (MTR) has challenged generations of neurosurgeons to achieve an appropriate approach. To address this challenge, the extensive use of the paramedian supracerebellar-transtentorial (PST) approach to expose the entire length of the MTR, as well as the fusiform gyrus, was investigated. Methods The authors studied the microsurgical aspects of the PST approach in 20 cadaver brains and 5 cadaver heads under the operating microscope. They evaluated the features, advantages, difficulties, and limitations of the PST approach and refined the surgical technique. They then used the PST approach in 15 patients with large intrinsic MTR tumors (6 patients), tumor in the posterior fusiform gyrus with mediobasal temporal epilepsy (MTE) (1 patient), cavernous malformations in the posterior MTR including the fusiform gyrus (2 patients), or intractable MTE with hippocampal sclerosis (6 patients) from December 2007 to May 2010. Patients...
BACKGROUND AND AIM Cranial nerve schwannomas almost always arise from sensory or mixed nerves. Mo... more BACKGROUND AND AIM Cranial nerve schwannomas almost always arise from sensory or mixed nerves. Motor cranial nerves, such as the trochlear nerve, are rarely associated with schwannomas. And, no consensus has yet been made for surgical intervention due to the low number of published cases for trochlear nerve schwannomas. This study comprises the systematic review of the literature and our experience for surgically treated trochlear nerve schwannomas. METHODS Three databases (Web of Science, PubMed, and Cochrane Library) were searched without date restrictions. Studies were included if they were published in the English literature, and presented patients with any age who underwent surgical treatment for trochlear schwannoma. And, data extracted from the included studies were combined with our experience. RESULTS Forty-one studies, presenting 43 patients, met the inclusion criteria. The total number of patients was 45 after adding our experience. The most common symptoms were diplopia (62,2%), headache (46,7%), and motor weakness (37,8%). Mean age during the diagnosis was 45,1 years. Although the subtemporal transtentorial approach (n=14) is the most preferred method, its application has decreased in recent years. And in the last decade, the lateral suboccipital approach (n=11) has gained popularity. Residual postoperative trochlear nerve deficit was detected in 81% of the patients. The probability of neurological deficit was statistically associated with neither tumor volume (p = 0,914) and location (p = 0,669), nor resection rate (p = 0,554). CONCLUSIONS Although trochlear schwannomas are quite rare cases and their treatment involves challenges, a total resection with the proper approach would provide the most desirable results.
OBJECTIVEThe semisitting position of a patient confers numerous advantages in various neurosurgic... more OBJECTIVEThe semisitting position of a patient confers numerous advantages in various neurosurgical procedures, but venous air embolism is one of the associated complications of this position. To date, no prospective studies of the relationship between the degree of head elevation and the rate and severity of venous air embolism for patients undergoing a procedure in this position have been performed. In this study, the authors compared changes in the severity of venous air embolism according to the degree of head elevation (30° or 45°) in patients undergoing an elective cranial neurosurgical procedure in the semisitting position.METHODSOne hundred patients undergoing an elective infratentorial craniotomy in the semisitting position were included, and each patient was assigned to 1 of 2 groups. In Group 1, each patient’s head was elevated 30° during surgery, and in Group 2, each patient’s head elevation was 45°. Patients were assigned to their group according to the location of thei...
Objective: Postoperative nausea and vomiting (PONV) is a common problem and its cause is multifac... more Objective: Postoperative nausea and vomiting (PONV) is a common problem and its cause is multifactorial. The relationship between PONV and nitrous oxide is under debate. The aim of this study was to evaluate the relationship between nitrous oxide and PONV in patients undergoing laparoscopic cholecystectomy. Patients and Methods: Forty premedicated female patients, ASA I or II, age 18-60 years and weigthing between 50-80 kg, were scheduled to undergo elective laparoscopic cholecystectomy. They were randomly assigned to two groups. Anaesthesia was induced in all patients with thiopental sodium, remifentanil and atracurium. Anaesthesia was maintained with sevoflurane, nitrous oxide in oxygen in group I and sevoflurane, air in oxygen in group II. Perioperatively remifentanil was infused in all patients. The patient’s PONV and pain scores were assessed 24 hours postoperatively. Results: In group I, PONV scores were significantly higher at the 1st and 4 th h postoperatively, however, there was no significant difference in group II. There was no significant difference in PONV and pain scores and the percentage of patients needing antiemetics between groups. No correlation was found between PONV and postoperative pain. Conclusion: Our data demonstrate that nitrous oxide does not increase the incidence or severity of PONV in patients undergoing laparoscopic cholecystectomy.
The aim of this study was to evaluate the analgesic efficacy of intravenous PCA using tramadol in... more The aim of this study was to evaluate the analgesic efficacy of intravenous PCA using tramadol in patients, undergoing supratentorial tumor resection with craniotomy. Material and Method: One hundred and fifty patients with ASA I-II between 18 and 70 years of age scheduled for an elective supratentorial craniotomy for tumor resection, were assigned to receive standardized general anesthesia. Postoperative pain was assessed at standard time intervals using a visual analogue scale (VAS) score. When the VAS score was >3, 1 to 1.5 mg/kg of tramadol was administered intravenously and PCA using tramadol was started. For 48 h postoperatively, the VAS, Glasgow coma, sedation, comfort, and nausea and vomiting scores were assessed. Results: During the first 48 hours, 46% of the patients needed analgesic therapy and PCA with tramadol was adequate for these patients. Most patients needed analgesic drugs at 2 hours and their mean analgesic usage was higher at that point than at other periods in the first 2 h (p<0.05). Conclusion: PCA with tramadol can be used effectively for postoperative pain management after craniotomy.
OBJECTIVE The objective of this study was to describe the distribution pattern of cerebellar hemi... more OBJECTIVE The objective of this study was to describe the distribution pattern of cerebellar hemispheric tentorial bridging (CHTB) veins on the tentorial surface in a case series of perimedian or paramedian supracerebellar approaches and to describe a novel technique to preserve these veins. METHODS A series of 141 patients with various pathological processes in different locations was operated on via perimedian or paramedian supracerebellar approaches by the senior author from July 2006 through October 2022 and was retrospectively evaluated. During surgery, the number and locations of all CHTB veins were recorded to establish a distribution map on the tentorial surface, divided into nine zones. Patients were classified into four groups according to the surgical technique used to manage CHTB veins: 1) group 1 consisted of CHTB veins preserved without intervention during surgery or no CHTB veins found in the surgical route; 2) group 2 included CHTB veins coagulated during surgery; 3)...
Journal of Anesthesiology and Reanimation Specialists’ Society, 2020
The virus pandemic called Covid-19 pandemic, has spread from Wuhan city of People's Republic of C... more The virus pandemic called Covid-19 pandemic, has spread from Wuhan city of People's Republic of China to the whole world in December 2019. It poses a risk to healthcare professionals due to patients and asymptomatic cases carrying the disease. In particular, operating theaters are among the most risky work areas in terms of aerosol forming processes and possible contact. For this reason, the establishment of perioperative operation protocols conveys importance. In this review; our "preoperative patient preparation and operating room operation protocols" including preoperative patient preparation, operating room organization and personal protection equipment which have particular importance are presented. Method: For this purpose, existing protocols and literature scanning have been made and the protocol created in the light of current information includes 3 subtitles as preoperative patient preparation, regulation of operating room procedures, and operating room cleaning at the end of the operation. Results: The protocol created was being used between March 15, and May 10, 2020. When the perioperative management is meticulously implemented in line with our protocols created in accordance with the internal functioning of our institution, it has been observed that the surgical process does not fail, besides safety of patients and employees may be reinforced. In the light of clinical protocols, COVID-19 suspected-infected patients can be identified in the preoperative period, and perioperative risks can be reduced and the safety of the patient, healthcare professionals and other patients can be increased.
Lesch-Nyhan disease is a rare X-linked recessive genetic disorder caused by a deficiency of hypox... more Lesch-Nyhan disease is a rare X-linked recessive genetic disorder caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase enzyme. The patients with Lesch-Nyhan Syndrome have several problems such as positioning and difficult intravenous cannulation because of spasticitiy. Also these patients have risk for bradycardia, pulmonary aspiration, convulsion and sudden death. Anesthetic implications of the patients with LeschNyhan Syndrome are not well described. Here we report our anesthesia experience in a 4 years-old child with Lesch-Nyhan syndrome, who underwent cataract surgery. Patients with Lesch-Nyhan syndrome should be carefully evaluated in the preoperative period especially to determine the difficulties in venous access and positioning. These patients should be closely monitored for the potential of pulmonary aspiration, and sudden death postoperatively.
OBJECTIVEThe object of this study was to present the surgical results of a large, single-surgeon ... more OBJECTIVEThe object of this study was to present the surgical results of a large, single-surgeon consecutive series of patients who had undergone transcisternal (TCi) or transcallosal-transventricular (TCTV) endoscope-assisted microsurgery for thalamic lesions.METHODSThis is a retrospective study of a consecutive series of patients harboring thalamic lesions and undergoing surgery at one institution between February 2007 and August 2019. All surgical and patient-related data were prospectively collected. Depending on the relationship between the lesion and the surgically accessible thalamic surfaces (lateral ventricle, velar, cisternal, and third ventricle), one of the following surgical TCi or TCTV approaches was chosen: anterior interhemispheric transcallosal (AIT), posterior interhemispheric transtentorial subsplenial (PITS), perimedian supracerebellar transtentorial (PeST), or perimedian contralateral supracerebellar suprapineal (PeCSS). Since January 2018, intraoperative MRI ha...
Objective We planned a cross-sectional analysis to determine the frequency and severity of metabo... more Objective We planned a cross-sectional analysis to determine the frequency and severity of metabolic acidosis in patients taking topiramate while awaiting craniotomy. Methods Eighty patients (18 – 65 years) taking topiramate to control seizures while awaiting elective craniotomy were enrolled. Any signs of metabolic acidosis or topiramate-related side effects were investigated. Blood chemistry levels and arterial blood gases, including lactate, were obtained. The severity of metabolic acidosis was defined according to base excess levels as mild or moderate. Results Blood gas analysis showed that 71% ( n = 57) of patients had metabolic acidosis. The frequency of moderate metabolic acidosis was 56% ( n = 45), while that of mild metabolic acidosis was 15% ( n = 12). A high respiratory rate was reported in only 10% of moderately acidotic patients. Conclusions In patients receiving topiramate, baseline blood gas analysis should be performed preoperatively to determine the presence and se...
Method: Diz artroskopisi geçirecek 40 hasta, 2 mL %2 prilokain ile spinal ya da 15-20 mL %2 prilo... more Method: Diz artroskopisi geçirecek 40 hasta, 2 mL %2 prilokain ile spinal ya da 15-20 mL %2 prilokain ile epidural anestezi yapılacak şekilde randomize olarak 2 gruba ayrıldı. Hastaların maksimum duyu bloğu seviyeleri, motor ve duyu bloğunun geri dönüş süreleri, ayağa ...
Gereç ve Yöntem: Elektif supratentoriyal kraniyotomi operasyonu planlanan, ASA I-II grubundan, 18... more Gereç ve Yöntem: Elektif supratentoriyal kraniyotomi operasyonu planlanan, ASA I-II grubundan, 18-70 yaş arasında 150 hasta çalışmaya dahil edilerek, propofol ve remifentanil ile standart genel anestezi uygulandı. Bupivakain ve epinefrin ile çivili başlık noktalarına ...
Amaç: Yaşlı hastalarda sık görülen travmatik kalça kırığının major tedavisi total kalça protezidi... more Amaç: Yaşlı hastalarda sık görülen travmatik kalça kırığının major tedavisi total kalça protezidir. Ancak bu girişim venöz tromboemboli gibi belirgin postoperatif komplikasyonlara neden olabilir. Bu çalışmada travmatik kalça kırığı nedeniyle total kalça protezi operasyonu ...
Object The exploration of lesions in the mediobasal temporal region (MTR) has challenged generati... more Object The exploration of lesions in the mediobasal temporal region (MTR) has challenged generations of neurosurgeons to achieve an appropriate approach. To address this challenge, the extensive use of the paramedian supracerebellar-transtentorial (PST) approach to expose the entire length of the MTR, as well as the fusiform gyrus, was investigated. Methods The authors studied the microsurgical aspects of the PST approach in 20 cadaver brains and 5 cadaver heads under the operating microscope. They evaluated the features, advantages, difficulties, and limitations of the PST approach and refined the surgical technique. They then used the PST approach in 15 patients with large intrinsic MTR tumors (6 patients), tumor in the posterior fusiform gyrus with mediobasal temporal epilepsy (MTE) (1 patient), cavernous malformations in the posterior MTR including the fusiform gyrus (2 patients), or intractable MTE with hippocampal sclerosis (6 patients) from December 2007 to May 2010. Patients...
BACKGROUND AND AIM Cranial nerve schwannomas almost always arise from sensory or mixed nerves. Mo... more BACKGROUND AND AIM Cranial nerve schwannomas almost always arise from sensory or mixed nerves. Motor cranial nerves, such as the trochlear nerve, are rarely associated with schwannomas. And, no consensus has yet been made for surgical intervention due to the low number of published cases for trochlear nerve schwannomas. This study comprises the systematic review of the literature and our experience for surgically treated trochlear nerve schwannomas. METHODS Three databases (Web of Science, PubMed, and Cochrane Library) were searched without date restrictions. Studies were included if they were published in the English literature, and presented patients with any age who underwent surgical treatment for trochlear schwannoma. And, data extracted from the included studies were combined with our experience. RESULTS Forty-one studies, presenting 43 patients, met the inclusion criteria. The total number of patients was 45 after adding our experience. The most common symptoms were diplopia (62,2%), headache (46,7%), and motor weakness (37,8%). Mean age during the diagnosis was 45,1 years. Although the subtemporal transtentorial approach (n=14) is the most preferred method, its application has decreased in recent years. And in the last decade, the lateral suboccipital approach (n=11) has gained popularity. Residual postoperative trochlear nerve deficit was detected in 81% of the patients. The probability of neurological deficit was statistically associated with neither tumor volume (p = 0,914) and location (p = 0,669), nor resection rate (p = 0,554). CONCLUSIONS Although trochlear schwannomas are quite rare cases and their treatment involves challenges, a total resection with the proper approach would provide the most desirable results.
OBJECTIVEThe semisitting position of a patient confers numerous advantages in various neurosurgic... more OBJECTIVEThe semisitting position of a patient confers numerous advantages in various neurosurgical procedures, but venous air embolism is one of the associated complications of this position. To date, no prospective studies of the relationship between the degree of head elevation and the rate and severity of venous air embolism for patients undergoing a procedure in this position have been performed. In this study, the authors compared changes in the severity of venous air embolism according to the degree of head elevation (30° or 45°) in patients undergoing an elective cranial neurosurgical procedure in the semisitting position.METHODSOne hundred patients undergoing an elective infratentorial craniotomy in the semisitting position were included, and each patient was assigned to 1 of 2 groups. In Group 1, each patient’s head was elevated 30° during surgery, and in Group 2, each patient’s head elevation was 45°. Patients were assigned to their group according to the location of thei...
Objective: Postoperative nausea and vomiting (PONV) is a common problem and its cause is multifac... more Objective: Postoperative nausea and vomiting (PONV) is a common problem and its cause is multifactorial. The relationship between PONV and nitrous oxide is under debate. The aim of this study was to evaluate the relationship between nitrous oxide and PONV in patients undergoing laparoscopic cholecystectomy. Patients and Methods: Forty premedicated female patients, ASA I or II, age 18-60 years and weigthing between 50-80 kg, were scheduled to undergo elective laparoscopic cholecystectomy. They were randomly assigned to two groups. Anaesthesia was induced in all patients with thiopental sodium, remifentanil and atracurium. Anaesthesia was maintained with sevoflurane, nitrous oxide in oxygen in group I and sevoflurane, air in oxygen in group II. Perioperatively remifentanil was infused in all patients. The patient’s PONV and pain scores were assessed 24 hours postoperatively. Results: In group I, PONV scores were significantly higher at the 1st and 4 th h postoperatively, however, there was no significant difference in group II. There was no significant difference in PONV and pain scores and the percentage of patients needing antiemetics between groups. No correlation was found between PONV and postoperative pain. Conclusion: Our data demonstrate that nitrous oxide does not increase the incidence or severity of PONV in patients undergoing laparoscopic cholecystectomy.
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