Browsing by Author "Aksu, Ugur"

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Are surgical and non-operating room intervention safe in the COVID-19 pandemic? A retrospective study
(CAMBRIDGE UNIV PRESS, 2021-01-01) Yildirim, Serap Aktas; Sarikaya, Zeynep Tugce; Ulugol, Halim; Ozata, Sanem; Aksu, Ugur; Toraman, Fevzi; Grp, C. O. V. I. D.-19 Study
Little is known about the impact of COVID-19 on the outcomes of patients undergoing surgery and intervention. This study was conducted between 20 March and 20 May 2020 in six hospitals in Istanbul, and aimed to investigate the effects of surgery and intervention on COVID-19 disease progression, intensive care (ICU) need, mortality and virus transmission to patients and healthcare workers. Patients were examined in three groups: group I underwent emergency surgery, group II had an emergency non-operating room intervention, and group III received inpatient COVID-19 treatment but did not have surgery or undergo intervention. Mortality rates, mechanical ventilation needs and rates of admission to the ICU were compared between the three groups. During this period, patient and healthcare worker transmissions were recorded. In total, 1273 surgical, 476 non-operating room intervention patients and 1884 COVID-19 inpatients were examined. The rate of ICU requirement among patients who had surgery was nearly twice that for inpatients and intervention patients, but there was no difference in mortality between the groups. The overall mortality rates were 2.3\% in surgical patients, 3.3\% in intervention patients and 3\% in inpatients. COVID-19 polymerase chain reaction positivity among hospital workers was 2.4\%. Only 3.3\% of infected frontline healthcare workers were anaesthesiologists. No deaths occurred among infected healthcare workers. We conclude that emergency surgery and non-operating room interventions during the pandemic period do not increase postoperative mortality and can be performed with low transmission rates.
Can Partial Oxygen Pressure of Urine be an Indicator for Tissue Perfusion?
(AVES, 2019-01-01) Tosun, Mclis; Ulugol, Halim; Aksu, Ugur; Toraman, Fevzi
Objective: None of the advanced monitorisation procedures, which are focusing only on the haemodynamic and blood gas parameters, are sufficient to estimate tissue perfusion adequately. The search for new parameters that are non-invasive and reliable to provide information about tissue hypoperfusion is significant. The purpose of the present study was to evaluate the relationship between urine partial pressure of oxygen (PuO2) and routine systemic tissue perfusion parameters in patients with sepsis-like syndrome and impaired cardiac pressure-volume relationship after an open cardiac surgery. Methods: The study was designed in 50 patients who had elective coronary bypass surgery. Patients were assessed for arterial lactate levels, arterial partial oxygen pressure (PaO2), cardiac output (CO) and PuO2 in bladder urine at 180, 360 and 540 min postoperatively. Results: Tissue perfusion parameters were found to be similar throughout the surgery in addition to no significant rise in plasma creatinine levels. PuO2 was found to be 91 +/- 22, 99 +/- 22 and 97 +/- 13 mmHg, respectively, at the time points described above. Any correlation between PuO2 and other measurements was not determined at any time points. Conclusion: The present study suggests that urine PuO2 has no relationship with routine systemic tissue perfusion parameters, such as PaO2, lactate levels and CO. In our opinion, since the COs of the patients were within the normal limits, and none of the patients developed renal injury, the present study might have been unable to determine any correlation. Further studies focused on patients with transient renal ischaemia are needed.
Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular Injury and Oxidative Stress in Cardiovascular Surgery
(MEDICAL TRIBUNE INC, 2019-01-01) Ulugol, Halim; Aksu, Ugur; Kocyigit, Muharrem; Kilercik, Meltem; Karduz, Gulsum; Okten, Murat; Toraman, Fevzi
Purpose: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery. Methods: In this randomized prospective study, after ethics approval and informed consent, 60 surgical patients were included. Patients undergoing coronary bypass surgery were randomized into two groups as warm blood cardioplegia (n = 30) and cold crystalloid cardioplegia (n = 30) following the cross-clamping. Measurements were performed at three time points: before induction of anesthesia (Ti), at admission to intensive care unit (ICU) (T2) and at the 24th postoperative hour (T3). Besides biochemical routine hemodynamic monitoring, patients were assessed for the sialic acid (SA), ischemic-modified albumin (IMA), advanced oxide protein products (AOPPs), total thiol (SH), and free hemoglobin (fHb) level. Results: Neither crystalloid nor blood cardioplegia led to significant changes in the AOPPs, T-SH, and SA level (p >0.05). Crystalloid cardioplegia, however, increased IMA level compared to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb levels were transiently increased in both groups at the second-time point (p <0.001). fHb level was lower in the crystalloid group compared to that in the other group (p <0.05) at T2. Conclusion: Cardioplegia type creates similar effects on glycocalyx integrity. However, myocardial protection could be provided with warm blood cardioplegia.
Effects of Alprazolam and Melatonin Used for Premedication on Oxidative Stress, Glicocalyx Integrity and Neurocognitive Functions
(AVES, 2018-01-01) Can, Meltem Guner; Ulugol, Halim; Gunes, Isin; Aksu, Ugur; Tosun, Melis; Karduz, Gulsum; Vardar, Kubra; Toraman, Fevzi
Objective: The purpose of this investigation was to compare the effect of alprazolam and melatonin on oxidative stress, glicocalyx integrity and neurocognitive function in patients undergoing coronary artery bypass grafting (CABG). Methods: Overall, 42 patients undergoing CABG were retrospectively included in this study. Blood samples which preserved at -70 degrees C for a previous study were used for this study. The participants were divided into two groups. Patients in the Group A were administered alprazolam before the operation, whereas melatonin was used for premedication in the Group M. Blood samples were collected at three time points {[}T0: before anaesthesia induction, T1: admittance to intensive care unit (ICU), T2: 24 h after ICU admission], and oxidative stress parameters and glicocalyx integrity were evaluated. Furthermore, Mini-Mental State Examination was recorded to measure neurocognitive function. Results: The total thiol levels which were measured as an antioxidant parameter were significantly higher, and free Hb values were significantly lower in the Group M compared to the Group A (p<0.05). No significant differences were found in order to oxidative stress parameter levels, extubation time, length of hospital stay, durations of cross-clamp, cardiopulmonary bypass and operation and Mini-Mental State Examination results between the two groups (p>0.05). Conclusion: In light of positive effects on oxidatif stress parameters, melatonin may be considered as a good and safe premedication agent with its anxiolytic, antioxidant and minimal haemodynamic and respiratory effects.
Effects of short-term hyperoxic ventilation on lung, kidney, heart, and liver in a rat model: A biochemical evaluation
(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2021-01-01) Aksu, Ugur; Ulugol, Halim; Sungur, Mukadder Orhan; Senturk, Evren; Vardar, Kubra; Senturk, Mert; Toraman, Fevzi
BACKGROUND: Despite studies on the adverse effects of hyperoxia, its use is still recommended by the World Health Organization. The aim of this study was to test the possible harmful effects of hyperoxia on the lung, kidney, heart, and liver in a rat mechanical ventilation model. METHODS: Male Wistar rats were randomly assigned into two groups (n=6/group): Normoxic (FiO(2): 0.3) or hyperoxic (FiO(2): 1.0) ventilation for 4 h. The injury was evaluated in bronchoalveolar lavage (BAL), blood, lung, liver, kidney, and heart was evaluated in terms of cell surface integrity, extracellular matrix (sialic acid, syndecan-1), osmotic stress (free hemoglobin), and redox homeostasis-lipid peroxidaation (malondialdehyde). BAL and wet/dry weight ratio were also evaluated for cellular permeability. RESULTS: Four hours of hyperoxic ventilation did not lead to significant changes in (1) sialic acid, syndecan-1, (2) malondialdehyde levels and wet/dry weight ratio in liver, kidney, heart, and lung compared to normoxic ventilation. CONCLUSION: Mechanical ventilation with hyperoxia seems to have almost similar effects compared to ventilation with normoxia. However, the long term effect of hyperoxia should be evaluated.
Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?
(BRAZILIAN SOC UROL, 2016-01-01) Ozgen, Serpil Ustalar; Ozveren, Bora; Kilercik, Meltem; Aksu, Ugur; Ay, Binnaz; Tufek, Ilter; Kural, Ali Riza; Turkeri, Levent N.; Toraman, Fevzi
Background: The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies. Patients and Methods: Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation. Exclusion criteria: The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery. Results: (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05)
Microcirculatory Response to Blood vs. Crystalloid Cardioplegia During Coronary Artery BypassGrafting With Cardiopulmonary Bypass
(FRONTIERS MEDIA SA, 2022-01-01) Aykut, Gueclue; Ulugoel, Halim; Aksu, Ugur; Akin, Sakir; Karabulut, Hasan; Alhan, Cem; Toraman, Fevzi; Ince, Can
Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB.Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T-0) to discontinuation of CPB (T-5).Results: In the both crystalloid {[}crystalloid cardioplegia group (CCG)] and blood cardioplegia {[}blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T-0 to T-5 (\%Delta)(T0-T5) in all the functional microcirculatory parameters {[}\%Delta TVDT0-T5(CCG): -10.86 +/- 2.323 vs. \%Delta TVDT0-T5(BCG): 0.0804 +/- 1.107, p < 0.001