Person: AYKAÇ, ZEYNEP ZUHAL
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AYKAÇ
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ZEYNEP ZUHAL
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Publication Metadata only Oxygen reserve index guided oxygen titration in one lung ventilation with low fresh gas flow(TUBITAK SCIENTIFIC & TECHNICAL RESEARCH COUNCIL TURKEY, 2021) SARAÇOĞLU, AYTEN; Saracoglu, Ayten; Sirzai, Esra Yamansavci; Yildizeli, Bedrettin; Yuksel, Mustafa; Aykac, Zeynep ZuhalBackground/aim: Continuous oxygen reserve index (ORI) measurement with multiple wave pulse co-oximetry is a noninvasive measurement. The decrease in the ORI trend provides a prediction for the development of hypoxemia and provides information on hyperoxia. Our aim is to determine the effect of ORI-guided oxygen titration on hyperoxemia-mediated morbidity. Materials and methods: Consecutive 120 ASA I-III patients, 18-70 years of age, without severe obstruction or restriction, undergoing one lung ventilation (OLV), were included in the study. Patients were divided into 4 groups. Oxygen titration without ORI monitoring with low-flow anesthesia (1 L/min, Group 1, n = 25) and high-flow anesthesia (4 L/min, Group 2, n = 28). Oxygen titration by ORI monitoring with low flow anesthesia (1 L/min, Group 3, n = 25) and high flow anesthesia (4 L/min, Group 4, n = 25). FiO(2) increased up to 100% if necessary. OLV time, duration of surgery and anesthesia, FiO(2) applied during OLV, oxygen application time (T) over 60%, vital signs, hospital and ICU stay time, and complications were recorded. Results: There was a statistically significant difference in terms of FiO(2) used during OLV (p < 0.05). There was no difference in ORI values (p < 0.05). In Group 3, both PaO2 and SpO(2) were significantly lower than the others both before and during OLV. There was no significant difference in terms of ORI parameters between low flow and high flow anesthesia groups. There was a strong, positive correlation between the duration of hospital stay and FiO(2) used above 80% during OLV. Conclusion: We concluded that ORI-guided thoracic anesthesia may reduce hospital stay and increase patient safety.Publication Metadata only Factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2020) AYKAÇ, ZEYNEP ZUHAL; Kilic, Bahriye; Yapici, Nihan; Yapici, Fikri; Kavakli, Ali Sait; Kudsioglu, Turkan; Kilic, Abdullah; Aykac, ZuhalBackground: The aim of this study was to investigate the intra-abdominal pressure changes and risk factors associated with increased intra-abdominal pressure in patients undergoing cardiac surgery. Methods: Between July 2016 and January 2017, a total of 100 patients (74 males, 26 females; mean age 55.9 +/- 14.3 years; range, 19 to 75 years) who underwent cardiac surgery under cardiopulmonary bypass were included in the study. Patients' data including demographic and clinical characteristics and intra- and postoperative data were recorded. Intra-abdominal pressure was measured via a urinary catheter after anesthesia induction, on admission to the intensive care unit, and at postoperative 12 and 24 h. The patients were divided into two groups according to the intra-abdominal pressure as Group 1 (>==12 mmHg; n=49) and Group 2 (<12 mmHg; n=51). Results: In the univariate regression analysis, high intra-abdominal pressure was related to intra-abdominal pressure measured after anesthesia induction (Odds Ratio = 0.70, p=0.001), age (odds ratio=0.95, p=0.004), hypertension (odds ratio=4.51, p=0.0001), duration of cardiopulmonary bypass (odds ratio=0.97, p=0.0001), intraoperative lactate levels (odds ratio=0.53, p=0.0001), use of red blood cells (odds ratio=0.24, p=0.0001), use of dopamine (odds ratio=0.21, p=0.002), dobutamine (odds ratio= 0.28, p=0.005), use of noradrenaline (odds ratio=0.25, p=0.016), postoperative lactate levels (odds ratio=0.60, p=0.0001), duration of cross-clamp (odds ratio=0.97, p=0.0001), atrial fibrillation (odds ratio=5.89, p=0.004), and acute kidney injury (odds ratio=8.33, p=0.048). In the multivariate analysis, the intra-abdominal pressure at baseline (odds ratio=0.70, p=0.045), age (odds ratio=0.93, p=0.032), hypertension (odds ratio=6.87, p=0.023), duration of cardiopulmonary bypass (odds ratio=0.98, p=0.062), intraoperative lactate levels (odds ratio=0.57, p=0.035), and use of red blood cells (odds ratio=0.19, p=0.003) remained statistically significant. Conclusion: Our study results suggest that age, hypertension, duration of cardiopulmonary bypass, intraoperative lactate levels, and use of red blood cells are risk factors associated with elevated intra- abdominal pressure in patients undergoing cardiac surgery. Increased awareness of these risk factors and the addition of intra-abdominal pressure measurement to the standard follow-up scheme in patients with variable hemodynamics, low cardiac output, and high lactate levels in the intensive care unit may be useful in early diagnosis of complications and in decreasing morbidity.Publication Metadata only Analysis of risk factors for sternal surgical site infection: Emphasizing the appropriate ventilation of the operating theaters(CAMBRIDGE UNIV PRESS, 2006) AYKAÇ, ZEYNEP ZUHAL; Yavuz, Serap Simsek; Bicer, Yesim; Yapici, Nihan; Kalaca, Sibel; Aydin, Osman Ozcan; Camur, Gercek; Kocak, Funda; Aykac, Zuhalobjective. To determine the incidence of and identify risk factors for sternal surgical site infection ( SSI). design. Prospective cohort study. Data on potential risk factors, including the type of operating theater and infection data, were collected prospectively and analyzed by multivariate analysis. setting. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, a 700- bed teaching hospital and the largest center for cardiac surgery in Turkey. The cardiothoracic unit performs approximately 3,000 cardiac operations per year. patients. All adult patients who underwent cardiac surgery with sternotomy between January 14, 2002, and July 1, 2002, and who survived at least 4 days after surgery were included in the study. results. Potential risk factor data were complete for 991 patients. There was sternal SSI in 41 patients ( 4.1%). Female sex, diabetes mellitus, operation performed in the older operating theaters, and duration of procedure exceeding 5 hours were identified as independent risk factors for sternal SSI. conclusions. Female and diabetic patients are at higher risk for sternal SSI and should be followed up carefully after cardiac surgery to prevent the development of sternal SSI. Reducing the duration of surgery could reduce the rate of postoperative sternal SSI. The operating theater environment may have an important role in the pathogenesis of sternal SSI, and appropriate ventilation of the operating theaters would be critical in the prevention of sternal SSI.Publication Metadata only N-Acetylcysteine is ineffective on short-term neuron-specific enolase levels following coronary artery bypass graft surgery(SPRINGER TOKYO, 2012) SARAÇOĞLU, AYTEN; Ugur, Engin H.; Yapici, Nihan; Kudsioglu, Turkan; Ugur, Sinem Y.; Yapici, Mehmet F.; Saracoglu, Ayten; Saracoglu, Kemal T.; Aykac, ZuhalPublication Metadata only Effects of N-acetylcysteine on myocardial ischemia-reperfusion injury in bypass surgery(SPRINGER, 2006) YALÇIN, AHMET SUHA; Orhan, G; Yapici, N; Yuksel, M; Sargin, M; Senay, S; Yalcin, AS; Aykac, Z; Aka, SAMyocardial ischemia-reperfusion injury may complicate coronary artery bypass grafting (CABG) operations. N-Acertylcysteine (NAC) had antioxidant and microcirculatory effects, and inhibits neutrophil aggregation. The aim of this study was to determine the effects of NAC in limiting myocardial ischemia-reperfusion injury in CABG operations. Twenty patients undergoing elective coronary bypass operation with cardiopulmonary bypass were enrolled and randomly assigned to two groups: a control group operated with a routine CABG protocol, and one where NAC was administered intravenously during the operation (NAC group). Blood samples from coronary sinus for tumor necrosis factor-alpha assay, myocardial biopsy specimens for chemiluminescent luminol, and lucigenin measurements of reactive oxygen species were taken. The luminol (specific for .-OH, H2O2, and HOCl- radicals) and lucigenin (specific for O-2(.-)) levels and the difference ratios after reperfusion were significantly lower in the NAC group. Tumor necrosis factor-alpha levels increased in the control group but, in contrast, a significant decrease was detected in the NAC group (P < 0.01). Creatine kinase-MB levels at 6 and 12 hours were singnificantly lower in the NAC group (P = 0.02). N-Acetylcysteine has potential effects to limit ischemia reperfusion injury during CABG operations. We believe that its effects on clinical outcome may be more apparent in patients prone to ischemia-reperfusion injury.