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A Dönmez

Publications and source records attributed to A Dönmez.

18 recordsLinked to original sources
PubMed2006

Our experience in cardiac transplantation in Baskent University.

Recently cardiac transplantation has an important place in treatment of end-stage cardiac failure. In Turkey between 2003 and 2005 at 10 centers 64 cardiac transplantations were performed including five at our facility. Herein we have presented our results. All patients were men of mean age 34.2 +/- 10.7 (17 to 44) years. Upon preoperative echocardiography their mean ejection fraction was 18% +/- 3.27% (17% to 23%). Pulmonary vascular resistance was 4.47 wood unit in one patient and in one case, there was Rh incompatibility between donor and recipient. We used HTK solution for protection of donor hearts. Mean ischemia time was 251.2 +/- 62.7 minutes (155 to 314). Mean aortic clamping time was 84 +/- 4.7 minutes (80 to 90). In all patients we performed a biatrial anastomosis technique. Hemofiltration was used to prevent hemodilution during operation. In the postoperative period four patients had acute renal dysfunction; one, a minor cerebrovascular accident; two, reoperated because of bleeding; one, cholestasis; one, temporary atrio-ventricular block; and one, mediastinitis. Mean follow-up time was 15.6 +/- 19.7 months (2 to 50). Neither early nor late mortality has occurred. All patients are in New York Heart Association class I. In all cases we used triple immunosuppressive therapy. In the follow-up period the mean number of cardiac biopsies per patient was 4.2 +/- 3.03 (2 to 8). Two cases had cardiac catheterization. As a complication of cardiac biopsy, pericardial tamponade developed in one patient; in another one we observed a right ventricular aneursym after cardiac biopsy. Cardiac transplantation was performed with low mortality and morbidity rates in end-stage cardiac failure patients with longer life expectancy and higher life quality. Unfortunately in our country, because of difficulties to find donor hearts, cardiac transplantations were small in number. For better results, we need a larger series.

Adolescent↗
PubMed2005

Syringe pumps take too long to give occlusion alarm.

BACKGROUND: The aim of this study was to assess the time needed to trigger an occlusion alarm, and the influence of the type of infusion pump, type and size of the syringe, and the set infusion rate. METHODS: Forty syringe pumps (20 JMS SP-100 and 20 JMS SP-500 machines) were tested using two types (JMS and Hayat) and two sizes (20 and 50 ml) of syringes at four infusion rates (0.5, 1, 2 and 5 ml x h(-1)). Syringes filled with saline were occluded with a stopcock, and times to activation of the occlusion alarm were recorded. Statistical analysis was performed with Wilcoxon and Mann-Whitney U-tests, P < 0.05 was considered significant. RESULTS: The mean time to alarm activation was longer with lower infusion rates and larger syringes (P < 0.05). We recorded delays up to 117.3 +/- 9.4 min with 50 ml syringe at 0.5 ml x h(-1) and 15.0 +/- 7.1 min at 5 ml x h(-1). Syringe type had no effect on time to alarm activation (P > 0.05). The alarm on the JMS SP-500 pump was activated faster than the JMS SP-100 pump (P < 0.05). CONCLUSION: Our results showed that activation of occlusion alarms on both pumps takes a considerable time, and that the mean time to alarm activation was longer with low infusion rates and larger syringes. To reduce occlusion alarm delays smaller sized syringes with low compliance should be used and staff be alerted when using low flow rates with highly concentrated potent drugs.

Equipment Failure↗
PubMed2001

One center's experience with remifentanil infusions for pediatric cardiac catheterization.

OBJECTIVE: To investigate the efficacy of a remifentanil infusion for pediatric cardiac catheterization. DESIGN: Prospective. SETTING: University hospital. PARTICIPANTS: Children undergoing cardiac catheterization (n = 55). INTERVENTIONS: All patients (age range, 2 months to 12 years) were premedicated with an oral mixture of hydroxyzine and midazolam 60 minutes before the procedure. A remifentanil infusion was initiated at 0.1 microg/kg/min before the start of cardiac catheterization. Noninvasive systolic blood pressure, heart rate, oxygen saturation (SpO(2)), respiratory rate, and sedation score were recorded before the remifentanil infusion and every 15 minutes thereafter throughout the procedure. Episodes of apnea, vomiting, pruritus, and muscle rigidity and recovery time were noted. MEASUREMENTS AND MAIN RESULTS: There were no significant changes in systolic blood pressure, heart rate, SpO(2), or respiratory rate during the procedure. The sedation scale scores at 30, 45, 60, 75, and 90 minutes of remifentanil infusion were significantly lower than the scores recorded at baseline and 15 minutes. In 23 patients, the remifentanil infusion maintained a satisfactory level of sedation, but 32 patients required additional drugs (18 received midazolam, and 14 received midazolam plus ketamine). Recovery was rapid after the remifentanil infusion was discontinued, with a mean time of 2.04 +/- 2.32 minutes to reach a recovery score of > or =5. Three patients experienced apnea after bolus doses of remifentanil, 1 patient vomited, and 1 patient complained of pruritus. CONCLUSION: In pediatric cases in which other intravenous analgesics and sedatives are contraindicated, remifentanil infusion appears to be a suitable alternative based on its associated rapid recovery and stable hemodynamics.

Anesthetics, Intravenous↗
PubMed1999

Is pancreatitis a complication of propofol infusion?

The effects of bolus and infusion doses of propofol on histopathological changes in the rat pancreas are reported. After obtaining Hospital Ethics Committee approval, 75 female Wistar rats were assigned to three study groups. Groups I (n = 30) and II (n = 30) received 10 mg kg-1 intravenous bolus of propofol; with propofol administered to group II at an infusion rate of 10 mg kg-1 h-1 for 30 min immediately after the bolus doses. Group III (n = 15) was used as the control group. Twenty-four hours after propofol administration blood samples and pancreatic tissue specimens were obtained under ether anaesthesia. Plasma cholesterol, triglyceride, amylase, and lipase levels were studied, and pancreatic tissues were examined under light microscopy. Plasma cholesterol and triglyceride levels were significantly higher in group II compared with the other groups. Differences between the groups in respect of plasma amylase and lipase levels were not statistically significant. Acute pancreatitis was observed under light microscopy, in three rats (10%) in group II, and in one rat (6.6%) in the control group. The pancreatic tissues of group I were normal. The incidence of acute pancreatitis in each of the groups was not significant. It is therefore suggested that, further controlled studies are needed to investigate the relation between pancreatitis and the use of propofol.

Acute Disease↗
PubMed1998

The effect of etomidate induction on plasma cortisol levels in children undergoing cardiac surgery.

OBJECTIVE: To investigate the effect of a single induction dose of etomidate on plasma cortisol and adrenocorticotrophic hormone (ACTH) levels in pediatric patients with congenital heart disease. DESIGN: A prospective, randomized study. SETTING: A university hospital. PARTICIPANTS: Thirty children undergoing cardiopulmonary bypass. INTERVENTIONS: Patients were randomly allocated into two groups to receive etomidate, 0.3 mg/kg, and fentanyl, 1 microg/kg, or ketamine, 1 mg/kg, and fentanyl, 1 microg/kg intravenously, for anesthesia induction. Anesthesia was maintained with 50% nitrous oxide and 0.5% isoflurane in oxygen. Plasma cortisol and ACTH levels were measured on five occasions: preoperatively, after induction of anesthesia, after cross-clamping, at the end of surgery, and 24 hours postoperatively. MEASUREMENTS AND MAIN RESULTS: Plasma cortisol levels of the etomidate group decreased with anesthesia induction and remained significantly low during cardiopulmonary bypass, at the end of operation, and 24 hours postoperatively. Plasma cortisol levels of the etomidate group after the anesthesia induction, during cardiopulmonary bypass, and at the end of the operation were significantly lower than the ketamine group. CONCLUSION: These results show that etomidate is a suitable agent for suppressing the increase in cortisol levels associated with the stress response caused by cardiopulmonary bypass in children with congenital heart defects, and can be used safely.

Adrenocorticotropic Hormone↗
PubMed1996

Oral ketamine premedication in children (placebo controlled double-blind study).

Ketamine 3-6 mg kg-1 given by mouth to paediatric patients for anaesthetic premedication was evaluated. Forty-three children, ages 2-9 years were randomly allocated to receive either ketamine (3 or 6 mg kg-1) or placebo (cola 0.2 mL kg-1). Oral use of ketamine made separation from the families easier, gave an increased level of sedation, made acceptance of mask application easier and improved the emotional state in the recovery phase. These improvements were present with ketamine 3 mg kg-1 and 6 mg kg-1 in comparison with the placebo. We conclude that 3 mg kg-1 ketamine given by mouth to premedicate paediatric patients is as effective as 6 mg kg-1 but has a decreased incidence of side effects such as nystagmus and vomiting.

Administration, Oral↗
PubMedDate not supplied

Systemic inflammatory response related to cardiopulmonary bypass and its modification by methyl prednisolone: high dose versus low dose.

The objective of our study was to investigate the safety and efficacy of high-dose methyl prednisolone (MP) in modifying the systemic inflammatory response (SIR) to cardiopulmonary bypass (CPB) and to compare its efficacy with low-dose MP in children undergoing cardiac surgery for congenital heart disease. Thirty children with congenital heart disease undergoing CPB were randomly assigned to two groups: group 1 (n = 15) received 30 mg/kg MP by an intravenous infusion for 30 minutes and group 2 (n = 15) received 2 mg/kg intravenously, before the onset of CPB. Postoperative clinical parameters were recorded, and serum interleukin (IL)-6 and 8 levels, acute phase reactants, and blood biochemistry were determined serially for both groups. In both groups plasma IL-6 and 8 levels were elevated above the preoperative levels at 2 and 24 hours after declamping. The peak levels were obtained at 2-hour samples. The difference between the two groups in terms of postoperative IL-6 and 8 levels was not statistically significant. C-reactive protein (CRP) levels and polymorphonuclear leukocyte counts, postoperative core temperature, duration of mechanical ventilation, period of stay in intensive care unit, oxygenation indices, and biochemical parameters of patients did not significantly differ in the two groups. Only 1 patient in group 1 had elevated liver enzymes, blood urea nitrogen, and creatinine in the postoperative period. No significant complications were observed due to treatment with high-dose MP. Although postoperative IL and CRP levels indicated a SIR in our patients, the clinical picture was apparently affected in only 1 patient and she was in the high-dose MP group. CPB initiates a SIR that is associated with an increase in neutrophil count, CRP, and IL-6 and 8 levels. High-dose (30 mg/kg) MP was not superior to low-dose (2 mg/kg) in blunting the SIR to CPB in pediatric patients undergoing open-heart surgery.

Anti-Inflammatory Agents↗