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    The effects of CO2 pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain in gynecological laparoscopic surgery: A prospective randomized controlled study
    (Elsevier Singapore Pte Ltd, 2022) Gunusen, Ilkben; Akdemir, Ali; Sargin, Asuman; Karaman, Semra
    Background: It is recommended to heat and humidity CO2 in laparoscopic surgery to prevent postoperative pain and hypothermia but information about its effects on hemodynamic and respiratory parameters is limited. We aimed to investigate the effects of standard and heated-humidified CO2 on hemodynamic and respiratory parameters, body temperature and pain in healthy patients. Methods: One hundred patients who underwent total laparoscopic hysterectomy for benign pathology were divided into two groups: Group CD (cold-dry) patients were administered standard CO2, while Group HH (heated-humidified) patients were administered 95% humidified insufflation at 37 degrees C. Hemodynamic and respiratory parameters, body temperature, pain score and blood count parameters were recorded. Results: A total of 96 patients were included in the study, taken from the 100 patients. Group HH (n:47) had only higher systolic blood pressure at 75, mean blood pressure at 50 and 55 and a lower heart rate between 15 and 45 min (p:0.049, 0.037, 0.013 respectively). Pain score, morphine consumption, end-tidal CO2 and arterial blood gas values were not different between the groups, with only body temperature from 40 min and minimum value being significantly higher (at a difference of 0.86-1.04 degrees C) in Group HH. Postoperative leukocyte, neutrophil and NLR (neutrophil-leukocyte ratio) were found to be higher in this group (p < 0.05). Conclusion: It has been found that both standard and heated-humidified CO2 do not constitute a problem in terms of hemodynamic and respiratory parameters in healthy patients. The heated-humidified CO2 group had only a higher core body temperature and inflammatory response. (C) 2021 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.
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    The Effects of Different Pressure Pneumoperitoneum Models Created By Standard or Heated-Humidified CO2 Insufflation on Ovary and Peritoneum: an Experimental Study in Rats
    (Springer Heidelberg, 2022) Gunusen, Ilkben; Akdemir, Ali; Gurel, Cevik; Sargin, Asuman; Taskiran, Dilek; Kuscu, Gokce Ceren; Celik, Kubra
    There is still controversy over whether structural and morphological changes can be observed in tissues depending on the carbon dioxide (CO2) nature or the applied intra-abdominal pressures (IAP). This study aimed to investigate the effects of different pressure or CO2 nature used for pneumoperitoneum in gynecological laparoscopic surgery on inflammation, DNA damage, oxidative stress, and histopathological changes in ovarian and peritoneal tissue. For this purpose, forty female rats were randomly divided into 6 groups and different pneumoperitoneum models were created in these groups. Rats in group other than control and sham groups received standard (CD) or heated-humidified CO2 (HH) insulations at low (4 mmHg) or high pressure (8 mmHg). The ovary and peritoneum sections were evaluated microscopically for apoptotic index (API) and API scoring was calculated. Tissue and plasma interleukin-6 (IL-6), tumor necrotizing factor-alpha (TNF-alpha), anti-Mullerian hormone (AMH) and 8-hydroxydeoxyguanosine (8-OHdG) levels were analyzed with enzyme-linked immunosorbent assay (ELISA). The most severe changes occurred in the 8CD group microscopically, while the least severe changes occurred in the 4HH group. All histopathological parameters except for ovarian apoptotic index and peritoneal PCNA at low pressure were higher in the CD group. TNF-alpha and 8-OHdG levels were higher in the CD group at both low and high pressures. Standard CO2 caused more prominent histopathological changes at high pressures and systemic inflammation in both pressure groups. The least change between the experimental study groups in terms of histopathological and biochemical was observed in the low-pressure heated-humidified group.
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    The effects of reflexology on anxiety and pain in patients after abdominal hysterectomy: A randomised controlled trial
    (Churchill Livingstone, 2018) Ozturk, Rusen; Sevil, Umran; Sargin, Asuman; Yucebilgin, M. Sait
    Objectives: This study aimed at finding out the effects of reflexology on pain, anxiety levels after abdominal hysterectomy. Desing & methods: The study was performed on women hospitalized in the intensive care unit and gynecology services of Ege University Hospital in Izmir after abdominal hysterectomy between September 2013 and September 2014. This study was designed and conducted as a randomized controlled trial. The study sample consisted of 63 female patients: 32 in the experimental group and 31 in the control group. The postoperative daily monitoring sheet, Spielberger State Anxiety Inventory (SAI), was employed to collect research data and "visual analog scale" to evaluate pain levels. Results: The female patients' average age was found to be 47.23 +/- 4.71. The three-day monitoring showed a significant difference between the experimental and control groups in terms of average pain levels and anxiety scores after reflexology (p < 0.05). Conclusion: Foot reflexology may serve as an effective nursing intervention to increase the well-being and decrease the pain of female patients after abdominal hysterectomy, and nurses should be aware of the benefits of reflexology.
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    The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study
    (Tubitak Scientific & Technical Research Council Turkey, 2019) Gunusen, Ilkben; Sargin, Asuman; Akdemir, Ali; Ergenoglu, Ahmet Mete
    Background/aim: Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia. Materials and methods: This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SIT), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded. Results: Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block level or ephedrine dose. The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights. The incidence of hypotension and the ephedrine dose were also higher in these subjects. Conclusion: SPX values and combined newborn and placenta weights are more predictive of sensory block level than SPF values in parturients receiving spinal anesthesia.
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    Evaluation of anthropometric measurements and clinical tests in the diagnosis of difffiicult airway in patients undergoing head and neck surgery
    (Tubitak Scientific & Technical Research Council Turkey, 2022) Baspinar, Sukru Mert; Gunusen, Ilkben; Sergin, Demet; Sargin, Asuman; Balcioglu, Sacittin Taner
    Background/aim: The aim of this study is to research the incidence of difficult airways and the effectiveness of anthropometric measurements and clinical tests used to predict difficult airways in patients undergoing head and neck surgery. Materials and methods: This study was performed on a total of 200 patients over the age of 18 who underwent head and neck surgery between December 2019 and March 2020. The demographic data of the patients in the preoperative period, previous operations/ radiotherapy history applied to the head and neck region, and obstructive sleep apnea syndrome symptoms were recorded. In the physical examination, the jaw structure, mouth opening, jaw movement, and tooth structure of the patients, modified Mallampati classification, head and neck movements, neck circumference, thyromental and sternomental distance, atlantooccipital joint mobility, upper lip bite test, Wilson risk scoring, and Cormack-Lehane classification were evaluated. Results: The difficult laryngoscopy rate was identified as 19%, and the difficult intubation rate as 8%. Operation history related to head and neck (p = 0.002), presence of at least two of the obstructive sleep apnea syndrome symptoms (p = 0.008), Modified Mallampati score (p = 0.009), Wilson risk score (p = 0.004), upper lip bite test (p < 0.0001) and mouth opening (p = 0.001) were found to be associated with difficult laryngoscopy. Modified Mallampati score (p = 0.002), Wilson risk score (p < 0.0001), upper lip bite test (p < 0.0001), mouth opening (p < 0.0001), sternomental distance (p = 0.003), Atlantooccipital joint mobility (p = 0.001), and Cormack-Lehane classification (p < 0.0001) were found to be associated with difficult intubation. According to multiple logistic regression analysis, the results obtained for sternomental distance and mouth opening were OR 0.8, 95% CI 0.6-1.1 and OR 0.2, 95% CI 0.1-0.4, respectively. Conclusion: In patients who underwent head and neck surgery, it was observed that the frequency of difficult airway was higher, and particularly the Modified Mallampati score, Wilson risk score, upper lip bite test, and mouth opening were associated with both difficult laryngoscopy and difficult intubation.
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    A randomized comparison of different doses of intrathecal levobupivacaine combined with fentanyl for elective cesarean section: prospective, double-blinded study
    (Springer Japan Kk, 2011) Gunusen, Ilkben; Karaman, Semra; Sargin, Asuman; Firat, Vicdan
    Levobupivacaine may produce a sensory and motor block different from that produced by bupivacaine, which is the most popular local anesthetic in parturients undergoing cesarean section. The aim of this study was to investigate the block characteristics, the clinical efficacy, surgeon and patient satisfaction, and hemodynamic effects of using different doses of intrathecal plain levobupivacaine combined with fentanyl. One hundred twenty women undergoing elective cesarean section with a combined spinal-epidural technique were enrolled. The parturients were randomly assigned to receive one of the following: levobupivacaine 5 mg (group 5), 7.5 mg (group 7.5) or 10 mg (group 10), all combined with fentanyl 25, 15 or 10 mu g, respectively. Anesthesia was effective in 60, 82.5 and 100% of the patients in the levobupivacaine 5, 7.5 and 10 mg groups, respectively. Levobupivacaine 10 mg provided longer durations of analgesia and motor block and greater patient and surgeon satisfaction, although the incidence of hypotension was lower in groups 5 and 7.5 than in group 10 (12.5, 17.5 and 42.5%, respectively). Intraoperative epidural supplementation was higher in group 5 than in group 7.5 (40 and 17.5%, respectively), whereas no patients in group 10 were given an epidural bolus dose. The incidence of hypotension was higher in the levobupivacaine 10 mg group, even though this group presented more effective anesthesia and greater patient and surgeon satisfaction compared with the levobupivacaine 5 and 7.5 mg groups. As a result, we believe that levobupivacaine 7.5 mg combined with fentanyl 15 mu g is suitable for combined spinal-epidural anesthesia in elective cesarean section.
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    The relationship between the Trendelenburg position and cerebral hypoxia in patients who have undergone robot-assisted hysterectomy and prostatectomy
    (Tubitak Scientific & Technical Research Council Turkey, 2017) Ozgun, Ali; Sargin, Asuman; Karaman, Semra; Gunusen, Ilkben; Alper, Isik; Askar, Fatma Zekiye
    Background/aim: This study aimed to evaluate the relationship between the Trendelenburg position and cerebral hypoxia in robot-assisted hysterectomy and prostatectomy. Materials and methods: A standardized mini-mental state examination was administered to 50 patients enrolled in the study 1 h before and after surgery. Near infrared spectroscopy (NIRS) values and hemodynamic and respiratory parameters were recorded after induction of anesthesia (baseline) and once every 20 min in the Trendelenburg position and supine positions. The relationship between the development of cerebral desaturation and the patient's position was examined. Results: For all patients, the baseline mean cerebral oxygen saturation (RSO2) on the right and left were 70.5 +/- 7.3% and 70.6 +/- 6.7%, respectively. Right RSO2 values at 20 min and 60 min in the Trendelenburg position decreased significantly, but they increased at 120 min. A significant positive correlation was found between right RSO2 and EtCO2 in the supine period following surgery, and between left RSO2 and EtCO2 at 60 min in the Trendelenburg and supine positions. The relationship between NIRS values and cognitive dysfunction was not significant. Conclusion: We found that cerebral saturation decreases as age increases, and cerebral desaturation may occur owing to the Trendelenburg position. There was no correlation between patients' cognitive function and NIRS values.