Person: UMUROĞLU, TÜMAY
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UMUROĞLU
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TÜMAY
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Publication Open Access The effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement in patients undergoing laparatomy(HINDAWI LTD, 2015) SARAÇOĞLU, AYTEN; Zengin, Senniye Ulgen; Saracoglu, Ayten; Eti, Zeynep; Umuroglu, Tumay; Gogus, Fevzi YilmazOBJECTIVES: To evaluate and compare the effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement, adverse effects, patients' satisfaction, mobilization, time to first defecation and time to discharge in patients undergoing laparotomy. Methods: Eighty patients (18 to 65 years of age) undergoing elective laparotomy were randomly divided into four groups (n=20 in each group): group C, placebo capsules and normal saline infusion perioperatively (control); group L, placebo capsules and lidocaine 1 mg/kg intravenous bolus dose followed by 2 mg/kg/h infusion until skin closure; group P, 150 mg oral pregabalin and normal saline infusion perioperatively; and group PL, 150 mg oral pregabalin and lidocaine 2 mg/kg/h infusion until skin closure. Hemodynamic parameters, visual analogue scale (VAS) scores, analgesic consumption, side effects, time to mobilization, time to first defecation, time to discharge and patients' satisfaction were recorded. Results: VAS scores of group L, group P and group PL were lower than group C (P<0.05). Morphine consumption of group P and group PL was lower than group C (P<0.05). Incidence of nausea in group C was higher than group L and group PL. Time to first defecation and mobilization were shorter in group L and group PL compared with group C (P<0.05). Conclusion: Preoperative oral pregabalin and perioperative intravenous lidocaine infusion decreased postoperative VAS scores. Preoperative oral pregabalin decreased morphine requirement and perioperative intravenous lidocaine infusion hastened gastrointestinal motility and mobilization, and decreased the incidence of nausea in patients undergoing laparotomy. Therefore, preoperative pregabalin with or without lidocaine provides superior pain relief in patients undergoing laparatomy.Publication Open Access Determining the factors affecting the development of perioperative complications according to aging stages(2022-06-01) ZENGİN, SENİYYE ÜLGEN; ORHON ERGÜN, MELİHA; ÇORMAN DİNÇER, PELİN; UMUROĞLU, TÜMAY; ORHON ERGÜN M., ZENGİN S. Ü., ÇORMAN DİNÇER P., UMUROĞLU T., AYKAÇ Z. Z.Objective: This study aimed to examine perioperative complication risks in elderly patients stratified by age. Method: Elderly patients (youngest-old, ages 65 to 74 years; middle-old, 75 to 84 years; and oldest-old, ≥85 years) and controls (20-30 years) who underwent surgical intervention under general anesthesia were included in this prospective observational study. Results: Two-hundred-sixty patients were included. Different age subgroups showed a different course in terms of perioperative complications. For any combined end-point of any perioperative complication, having a body mass index>28 [odds ratio (OR): 2.4; 95% confidence interval (CI): 1.2-4.6; p=0.012] and being on multi-pharmacy regimen at baseline (OR: 1.9; 95% CI: 1.1-3.5; p=0.029) emerged as significant independent predictors. In reference to controls, each elderly age group emerged as a significant independent predictor: youngestolds (OR: 4.9; 95% CI: 2.2-10.8; p<0.001); middle-olds (OR: 2.5; 95% CI: 1.1-5.4; p=0.025); oldest-olds, (OR: 5.6; 95% CI: 2.5-12.6; p<0.001). Conclusion: Elderly patients appear to have higher risk for intraoperative and postoperative complications when compared to the young patients, and each age group appears to have increased risk for different type of complications.Publication Open Access Targeted bleeding management guided by non-invasive haemoglobin measurement in surgical patients(2022-10-01) AKDAĞ, ŞÜKRİYE; ZENGİN, SENİYYE ÜLGEN; UMUROĞLU, TÜMAY; AYKAÇ, ZEYNEP ZUHAL; SARAÇOĞLU, AYTEN; AKDAĞ Ş., ZENGİN S. Ü. , Cakmak G., UMUROĞLU T., AYKAÇ Z. Z. , SARAÇOĞLU A.© 2022 College of Physicians and Surgeons Pakistan. All rights reserved.Objective: To assess blood transfusion decisions in blood losses using a continuous total haemoglobin (SpHb) and non-invasive haemoglobin (Hb) device. Study Design: Double-blinded randomised controlled trial. Place and Duration of Study: Marmara University Hospital, Istanbul, Turkey, from March 2018 to December 2019. Methodology: One hundred and twenty adult patients scheduled for elective major surgery and expected to experience a blood loss greater than 20% of their total blood volume were divided into two groups. These groups were compared for bleeding management with conventional blood gas sampling (Group Hb, the control group) according to Hb monitoring versus SpHb measurement (Group SpHb, the study group). Results: In the postoperative measurement, there were fewer red blood cells (RBC) in the SpHb group than in the Hb group (p=0.020). There was a greater change in the amount of RBC from the perioperative to the postoperative period in the SpHb group compared to the Hb group (p<0.001). Postoperative Hb levels of patients in the intensive care unit (ICU) were higher in the SpHb group than in the Hb group (p<0.05). Conclusion: SpHb can provide effective patient blood management in cases of major surgery. It does not cause a delay in the decision of blood transfusion during surgery.Publication Open Access Pediatrik hastalarda postoperatif deliryum gelişmesi ile analjezi nosisepsiyon index değerleri arasındaki ilişkinin belirlenmesi(2022-01-01) ORHON ERGÜN, MELİHA; ÇORMAN DİNÇER, PELİN; UMUROĞLU, TÜMAY; ZENGİN, SENİYYE ÜLGEN; ÖZALTUN F., ZENGİN S. Ü., ORHON ERGÜN M., ÇORMAN DİNÇER P., UMUROĞLU T.Publication Open Access Comparative efficacy of finger versus forehead plethysmographic variability index monitoring in pediatric surgical patients(2022-10-01) FİDAN, SEYFULLAH; ZENGİN, SENİYYE ÜLGEN; ORHON ERGÜN, MELİHA; UMUROĞLU, TÜMAY; Fidan S., ZENGİN S. Ü. , ORHON ERGÜN M., UMUROĞLU T.Introduction The Plethysmographic Variability Index can be measured by both finger and forehead probes. Vasoconstriction may jeopardize the reliability of finger PVI measurements in pediatric patients undergoing surgery. However, forehead vasculature exhibits more marked resistance to alterations in the vasomotor tonus. Objective Our aim was to compare the Plethysmographic Variability Index measured via finger or forehead probes in mechanically ventilated pediatric surgery patients in terms of their ability to predict fluid responsiveness as well as to determine the best cut-off values for these two measurements. Materials and Methods A total of 50 pediatric patients undergoing minor elective surgery were included after provision of parental consent and ethics committee approval. Perfusion index measured at the finger or forehead and Plethysmographic Variability Index monitoring comprised the primary assessments. Hemodynamic parameters monitored included perfusion index, Plethysmographic Variability Index, and cardiac output. A >= 15% increase in cardiac output following passive leg raise maneuver was considered to show fluid responsiveness. Two groups were defined based on fluid responsiveness: Group R (responsive) and Group NR (non-responsive). Student\"s t-test, Mann-Whitney U test, DeLong test, and ROC were used for statistical analysis. Results The area under curve for finger and forehead Plethysmographic Variability Index prior to passive leg raise maneuver were 0.699 (p = .011) and 0.847 (p < .001), respectively. The sensitivity for finger and forehead measurements at a cut-off value of <= 14% was 92.9% and 96.4%, and 45.4% and 72.7%, respectively. Conclusion Although forehead and finger Plethysmographic Variability Index monitoring were similarly sensitive in predicting fluid responsiveness in pediatric surgical patients, the former method provided higher specificity. The best cut-off value for PVI measurements with forehead and finger probes was found to be 14%.Publication Metadata only Goal-Directed Fluid Management Using Plethysmographic Variability Index in Patients Undergoing Laparoscopic Bariatric Surgery(MARY ANN LIEBERT, INC) ORHON ERGÜN, MELİHA; Ergun, Meliha Orhon; Zengin, Seniyye Ulgen; Umuroglu, TumayBackground: Optimal intraoperative fluid management is essential in surgical patients, including individuals with obesity undergoing bariatric surgery. The objective of this study was to assess the feasibility of pleth variability index (PVI) for intraoperative goal-directed fluid management in comparison with standard approach, in patients with obesity undergoing laparoscopic bariatric surgery. Methods: A total of 60 patients with obesity who underwent elective laparoscopic bariatric surgery were included in this single-blind prospective randomized study. Patients were randomly assigned to the PVI group or control. Patients were monitored for PVI, heart rate, noninvasive mean blood pressure, and perfusion index. In addition, administered fluids, amount of bleeding, and renal function parameters were recorded. Results: The PVI group received higher amounts of crystalloids (3053 +/- 275 mL vs. 1703 +/- 349 mL, p < 0.001) and colloids (277 +/- 208 mL vs. 17 +/- 91 mL, p < 0.001) intraoperatively, and it had higher perioperative urine output. In addition, the PVI group had decreases in blood urinary nitrogen (BUN), lactate, and creatinine levels; however, controls had increased BUN, lactate, and creatinine. Conclusions: Findings of this study suggest that PVI may represent a useful noninvasive strategy for intraoperative goal-directed fluid management in patients with obesity undergoing laparoscopic bariatric surgery.Publication Metadata only Neutrophil gelatinase associated lipocalin in predicting postoperative acute kidney injury in elderly(SPRINGER LONDON LTD) ORHON ERGÜN, MELİHA; Orhon Ergun, Meliha; Zengin, Seniyye Ulgen; Mustafayeva, Aynur; Umuroglu, TumayBackground Elderly patients are at increased risk of developing acute kidney injury (AKI) following major surgery and rapid diagnosis is essential. Aim This study aimed to examine the potential utility of plasma neutrophil gelatinase associated lipocalin levels in early prediction of AKI in geriatric patients undergoing laparotomic oncological surgery. Methods This prospective single-center cohort study included 60 geriatric patients (>= 65 years of age) that underwent major oncologic surgery with laparotomy. Perioperative measurements of plasma creatinine, blood urinary nitrogen, plasma lactate, urine output, and neutrophil gelatinase associated lipocalin (NGAL) were made. Patients were followed for AKI development, which is the primary outcome measure, and predictive role of NGAL was investigated. Results At 48 h follow-up, AKI developed in 13 patients (21.7%). Significant differences in creatinine (p < 0.001), NGAL (p < 0.001), and urine output levels (p = 0.001) were evident over time between the two groups. High NGAL measurements at 6 and 24 h after surgery seem to be highly predictive of AKI development. At 6 h, a plasma NGAL level greater than 71.8 ng/mL has a sensitivity and specificity of 85% and 81% in predicting subsequent AKI development. Conclusions Plasma NGAL levels seem to represent an early and reliable marker for AKI in elderly patients undergoing laparotomic surgery with the potential to allow early diagnosis and prevent further renal deterioration. Further confirmatory studies are warranted. Trial registration The study was registered to ClinicalTrials.gov (number, NCT05030727). Implication statement Elderly patients are at increased risk of postoperative acute kidney injury (AKI). This study shows that plasma neutrophil gelatinase associated lipocalin is a helpful marker to predict AKI in elderly patients undergoing laparotomic major surgery, which will allow early diagnosis and prevent further renal deterioration in this vulnerable patient group.Publication Open Access Analgesic efficacy and opioid sparing effect of erector spinae planeblock in oncologic breast surgery: An observational study(2022-03-01) ORHON ERGÜN, MELİHA; UMUROĞLU, TÜMAY; ZENGİN, SENİYYE ÜLGEN; UĞURLU, MUSTAFA ÜMİT; ORHON ERGÜN M., ZENGİN S. Ü., mustafayeva a., UĞURLU M. Ü., UMUROĞLU T.Background/Aim: Erector spinae plane block (ESPB) is a fascial plane block technique suitable for perioperative analgesia. This study aimed to evaluate the value of ESPB performed under ultrasound guidance and with ANI (Analgesia Nociception Index) monitoring in terms of intraoperative opioid need and postoperative pain management, in patients undergoing oncological breast surgery. Methods: This prospective case-control study includes forty-two female breast cancer patients who underwent unilateral modified radical mastectomy with axillary lymph node dissection. Patients were allocated to receive (ESPB group) or not receive (controls) ultrasound guided ESPB before anesthesia induction based on patient preference, and the groups were compared in terms of total intraoperative opioid consumption (with the guidance of ANI) and postoperative pain. Visual analogue scores (VAS) were obtained during the 12-hour postoperative follow-up. Results: Total intraoperative remifentanil dose required was significantly lower in the ESPB group when compared to controls (361.9 (108.3) vs. 1560.0 (4), P<0.001). ESPB group had significantly lower visual analogue scores at all postoperative time points. None of the patients in the ESPB group but all controls required additional analgesia during the 12-hour postoperative follow-up period. Conclusion: Ultrasound guided ESPB together with ANI monitoring is an effective and relatively safe perioperative analgesia method in patients undergoing mastectomy. Together, they provide an effective postoperative analgesia and reduce intraoperative opioid use consumption. Further studies will shed more light on the role of ESPB in this setting.Publication Open Access Potential value of pleth variability index in intraoperative fluid management of geriatric surgical patients(2022-03-01) ORHON ERGÜN, MELİHA; UMUROĞLU, TÜMAY; BİLGİLİ, BELİZ; ZENGİN, SENİYYE ÜLGEN; ORHON ERGÜN M., ZENGİN S. Ü., BİLGİLİ B., UMUROĞLU T.Aim: This study was designed to determine the effects of pleth variability index (PVI) guided monitoring on the optimal intravascular volume replacement during hip and knee arthroplasty in geriatric patients, and whether using PVI could reduce blood transfusion and vasopressor requirements. Methods: One-hundred geriatric patients who underwent elective hip and knee arthroplasty were included, assigned to either PVI group (volume replacement was PVI guided) or to a control group (volume replacement was based on traditional methods). Sealed envelope technique was used for randomization. Perioperative hemodynamic parameters, infusion rate of crystalloids, colloids, blood/blood products, ephedrine hydrochloride requirements and perioperative urine outputs were recorded. Results: Crystalloid infusion rate was higher (9.5 vs. 6.8 ml/kg/h, p<0.001) and ephedrine requirement was lower (2.0% vs. 38.0%, p<0.001) in group PVI. Postoperatively, the percentage of patients with high BUN, creatinine, and lactate levels were higher among controls (p<0.001). PVI group had significantly lower mean heart rate intraoperatively. Conclusions: Our findings suggest that intraoperative fluid replacement guided by PVI monitoring provides hemodynamic stability, preserves normal levels of BUN, creatinine, and lactate, and reduces unnecessary use of vasopressor agents in elderly surgical patients.Publication Open Access Topical and systemic analgesia versus caudal epidural and dorsal penile nerve block in relieving pain after pediatric circumcision(MARMARA UNIV, FAC MEDICINE, 2021-10-31) ZENGİN, SENİYYE ÜLGEN; Karatas, Ayse; Eti, E. Zeynep; Umuroglu, Tumay; Zengin, Seniyye Ulgen; Gogus, F. YilmazObjective: There is no consensus on the use of optimal analgesic method after pediatric circumcision, although, caudal block (CB), dorsal penile nerve block (DPNB), topical local anesthetic application and systemic analgesic administration are frequently used methods. In this study, we aimed to compare the postoperative analgesic effects and side effects, as well as parental satisfaction concerning these methods. Patients and Methods: Eighty children, aged 3-12 years, undergoing circumcision were randomized into four groups (n=20). Group Caudal Anesthesia (CA), Group Dorsal Penile Blok (DP), Group Topical Analgesia (TA), Group Systemic Analgesics (SA). The severity of pain was measured with NRS or CHEOPS scores. Time to awakening, first analgesic requirement, hospital discharge, side effects and parental satisfaction were recorded. Results: In groups CA and DP, pain scores during the first postoperative hour were lower than the pain scores of other groups and in group CA, the first analgesic requirement time was significantly longer compared to other groups (p<0.05). In the early postoperative hour, parental satisfaction was higher in group CA compared to other groups. Conclusion: In the early postoperative period, CB and DPNB reduce pain more effectively and provide more parental satisfaction than other applications, (in children who underwent) circumcision.