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Öğe Bir Üniversite Hastanesinde Üçüncü Basamak Yoğun Bakım Hastalarında Tanıya Göre Maliyet Analizi(2019) Peker, KevserAmaç: Bu araştırmada, hastane maliyetleri içinde çok önemli bir yer tutan yoğun bakım ünitele- rinde (YBÜ) tanıya göre maliyetleri ortaya çıkarmak için YBÜ’lerinde gelir ve giderler arasındaki farkları hesaplayarak maliyet kontrolü ve verimliliğin yükseltilmesi amaçlanmıştır. Yöntem: YBÜ’de tedavi edilen hastaların gelir ve gider verileri bilgi işlem ve fatura bölümlerinden alınarak hasta tanısına göre maliyetler analiz edilmiştir. Hastaların demografik verileri, yatış süreleri, yoğun bakım sonuçları, yoğun bakımın toplam gelir ve giderleri ile hastaların tahlil, tedavi ücretleri, ilaç ve sarf malzeme ücretleri ayrı ayrı değerlendirilmiştir. Bulgular: Bu araştırmaya toplam 115 hasta dahil edilmiştir. Hastaların yatış tanı grupları akut repiratuvar distres sendromu, pulmoner ödem, zehirlenme, trafik kazası, kronik obstrüktif akciğer hastalığı (KOAH), pnömoni, pulmoner emboli, postoperatif hasta ve nedeni bilinmeyen kardiyak arrest şeklindedir. Doğrudan ilk malzeme ve ilaç giderleri hesap edildiğinde yoğun bakımda KOAH grubunda hasta başına elde edilen gelirin 619.47 Türk lirası olduğu, postoperatif grupta ise mali- yet kaybı olduğu gözlendi. Sonuç: YBÜ’lerinde maliyet analizi yöntemlerinin kullanılması hem mevcut tedavilerin devamını hem de ihtiyaca göre yeni düzenleme yapmayı olası kılabilir. Aynı zamanda kısıtlı kaynakların en verimli şekilde kullanılması sağlanabilir. Böylece yoğun bakım hastalarının gelişmiş tedavilere ulaşması daha kolay olabilir.Öğe The Effect of Erector Spinae Plane Block on Laparoscopic Cholecystectomy Anesthesia: Analysis of Opioid Consumption, Sevoflurane Consumption, and Cost(MARY ANN LIEBERT, INC, 2020) Peker, Kevser; Akçaboy, Zeynep Nur; Aydin, Gülçin; Gencay, Işın; Şahin, Ahmet Tugrul; Koçak, Yahya Fatih; Peker, Seydi AliBackground: Erector spinae plane (ESP) block has been increasingly suggested for laparoscopic cholecystectomy (LC) as a part of multimodal analgesia in many studies. However, there is not any study that investigated the perioperative effects of ESP block on anesthetic agent consumption and cost of LC anesthesia. This is the first study that evaluates the effect of ESP block in terms of cost-effectiveness, intraoperative consumption of inhalation agents, and perioperative consumption of opioids. Materials and Methods: In this prospective observational study, 81 patients who underwent LC were included. Patients were divided into two groups: In Group ESP (n = 39) bilateral ultrasound-guided ESP block was performed in preoperative period and in Group non-ESP (n = 42) ESP block was not performed. After standard general anesthesia protocol, anesthesia was maintained with 2% sevoflurane in 50% air and 50% oxygen with controlled ventilation in both groups. All patients were monitored with electrocardiography, noninvasive blood pressure, pulse oximetry, end-tidal carbon dioxide, and bispectral index. The consumption of sevoflurane and opioids in the intraoperative and postoperative 24 hours was recorded. The costs of drugs were determined by multiplying total consumed amounts with unit prices. Results: The costs and the consumed amounts of remifentanyl, sevoflurane, and tramadol were significantly higher in non-ESP group in the perioperative period (respectively, P < .001, P = .01, and P < .001). Conclusions: ESP block for LC decreased the consumed amount and cost of inhaled agents and opioids in the perioperative period.Öğe Effects of intravenous and mask induction on post-operative emergence delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy(SPRINGER LONDON LTD, 2020) Peker, Kevser; Polat, ReyhanBackground Emergence delirium occurs in children during recovery from general anesthesia. The aim of the study was to examine the effects of mask and intravenous sevoflurane anesthesia induction on emergence delirium in children undergoing tonsillectomy with or without adenoidectomy. Methods This single-blinded, prospective, randomized clinical trial was conducted in the operating room and the post-operative recovery area at a university hospital. Sixty-seven children (aged 3-12 years) were randomly assigned to receive either mask induction (group M) or intravenous induction (group IV). Vascular access was provided in group M after 8% sevoflurane and 60% nitrous oxide in oxygen were given through a mask. In the IV cohort, an intravenous cannula was inserted prior to induction. The incidence of emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale after arrival in the post-anesthesia care unit. Post-operative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Results PAED scores were significantly higher in group M at 5 min (group M = 12.2 +/- 4.215, group IV = 9.1 +/- 4.0; mean difference = 3.094, 95% CI [1.108; 5.081]; P = 0.003), at 15 min (group M = 8.0 +/- 2.6, group IV = 5.1 +/- 2.3; mean difference = 2.942, 95% CI [1.586-4.301]; P < 0.001), and at 30 min (group M = 5.1 +/- 2.8, group IV = 2.5 +/- 1.8; mean difference = 2.620, 95% CI [1.457; 3.783]; P < 0.001) than in group IV. The FLACC scale scores were similar between the two groups. Conclusion Mask induction for pediatric patients undergoing tonsillectomy with or without adenoidectomy increased Pediatric Anesthesia Emergence Delirium scores more than intravenous induction.Öğe The effects of ketamine and lidocaine on free radical production after tourniquet-induced ischemia-reperfusion injury in adults(2019) Peker, Kevser; Ökesli, Selmin; Kıyıcı, Aysel; Deyişli, CemileBACKGROUND: The primary aim of this study was to compare the effects of a small-dose infusion of 2 antioxidant agents, ketamine and lidocaine, on ischemia-reperfusion injury (IRI) in patients undergoing elective lower limb surgery. Ischemia-modified albumin (IMA), lactate, and blood gas levels were all measured and assessed. METHODS: A total of 100 patients who underwent lower extremity surgery were randomized into 3 groups. After spinal anesthesia, the ketamine group (Group K, n=33) was given a ketamine infusion, a lidocaine infusion was administered to the lidocaine group (Group L, n=33), and in the control group (Group C), 0.9% a sodium chloride infusion was performed. Blood samples were obtained for IMA analysis before anesthetic administration (baseline), at 30 minutes of tourniquet inflation (ischemia), and 15 minutes after tourniquet deflation (reperfusion). Arterial blood gas measurements were determined before anesthetic administration and 15 minutes after tourniquet deflation. RESULTS: The lactate and IMA levels at reperfusion were significantly lower in both the ketamine group and the lidocaine group when compared with the control group. CONCLUSION: The administration of both ketamine and lidocaine infusions significantly decreased skeletal muscle IRI-related high lactate and IMA levels. These results suggest the possibility of the clinical application of ketamine or lidocaine infusions in cases of skeletal muscle-related IRI.Öğe Hemangioma Turned Into a Gigantic Tongue: A Rare Case of Maffucci Syndrome(Erciyes Univ Sch Medicine, 2021) Peker, KevserBackground: This is a rare case of Maffucci syndrome who underwent orthopedic surgery owing to enchondroma and who had hemangiomas in the tongue tip. Case Report: After anesthesia induction, a 60-year-old male patient was intubated with direct laryngoscopy without any trauma to the hemangioma. However, before extubation, the edema in the patient's tongue was observed to slightly increase. After the endotracheal tube was removed, the patient had stridor, the airway was obstructed, the patient could not tolerate this condition, and he was subsequently reintubated. It was observed that the hemangioma in the tongue tip was dilated. The patient was followed up in the intensive care unit for 1 day and was extubated the following day with the reduction of hemangioma and tissue edema. Conclusion: The examination of hemangiomas, especially in the upper airway, requires careful attention from an anesthetic point of view.Öğe The Comparison of FLACC and OPS Scales in Differentiating Pain and Emergence Delirium in the Postoperative Period in Pediatric Patients(2020) Peker, Kevser; Peker, Seydi AliObjective: Postoperative pain and pediatric emergence delirium (ED) are early-postoperative negative behaviours. However it is very difficult to diferentiate each other. The aim of the present study is to compare the utility of “Face, legs, Activity, Cry, Consolability” (FLACC) and Objective Pain Scale (OPS) in differentiating the pain and ED in the early postoperative period. Materials and Methods: This prospective study was conducted at a university hospital. Sixty one (61) children were included in this study. General anesthesia was provided for all children. The incidence of ED was evaluated with PAED scale, the incidence of pain was evaluated with both FLACC and OPS scales in the early postoperative period. Results: Only the number of children with delirium were 29 (47.5%), with pain were 10 (16.4%) and with both delirium and pain were 25 (40.9%). For FLACC, the area under the curve (AUC = 0.914, p = 0.02) at the 5th minute and the area under the curve value (AUC = 0.865, p < 0.001) at the 15th minute was high. Conclusions: The utility of FLACC is better than OPS in differentiating pain and emergence delirium in the postoperative period in pediatric patients.Öğe The effect of erector spinae plane block on cost of percutaneous nephrolithotomy surgery(2020) Peker, Kevser; Peker, Seydi AliAim: The analgesic effect of ESPB for percutaneous nephrolithotomy have been reported in a few study. However there is not any study yet in terms of the effect of ESPB on the cost of anesthesia. The aim of the study is to evaluate the effect of ESPB on sevoflurane and opioid consumption and cost for percutaneous nephrolithotomy. Material and Method: The patients who underwent percutaneous nephrolithotomy were divided into two groups as ESPB group (Group B; N, 30) and non-ESPB group (Group K; N, 31) whether ESPB was performed or not in this prospective observatioanl study. Total consumption of sevoflurane, remifentanyl and total consumption of tramadol was recorded. Total consumption of sevoflurane, remifentanil and tramadol was multiplied by the unit price of the drug (milliliter and milligram) for determining cost estimation. Results: The total amount of remifentanil, sevoflurane and tramadol consumption were significantly lower in the Group B (respectively; p=0.009, p=0.001, p<0.001). The total remifentanil, sevoflurane and tramadol costs were found to be statistically significantly lower in the Group B (respectively: p=0.006, p=0.001, p<0.001). Conclusion: The ESPB is a cost-effective procedure and contributes to the multimodal anesthesia.Öğe The effect of preemptive retrolaminar block on lumbar spinal decompression surgery(Springer, 2024) Peker, Kevser; Aydin, Guelcin; Gencay, Isin; Saracoglu, Ayse Gizem; Sahin, Ahmet Tugrul; Ogden, Mustafa; Peker, Seydi AliPurpose Spinal decompression surgery causes severe pain. Retrolaminar block (RLB) is block, which is done by infiltration of local anesthetic to block spinal nerves between the lamina and superior costotransversospinalis muscle. The primary aim of this study is to evaluate the effectiveness of RLB on postoperative analgesia in patients undergoing spinal surgery. Secondary aims are effects on additional anesthetic and analgesic consumption. Methods The sixty (60) patients who underwent lumbar spinal surgery between May 2020 and May 2021 under general anesthesia with or without applied preemptive RLB for postoperative analgesia were included in this prospective observational study. Group I received ultrasound-guided preemptive RLB. In Group II, no intervention was performed. Postoperative VAS scores were compared in groups as primary outcome, perioperative additional anesthetic and analgesic needs were compared as secondary outcome. Results There was a significant difference between the groups in favor of the RLB group in terms of postoperative VAS scores at rest [1.33 (0.33-3.509)] and movement [2.40 (1.20-4.00)] (p < 0.001). Perioperative sevoflurane consumption was significantly low in block group (p < 0.001). Postoperative tramadol consumption was lower in Group I compared with Group II [Group 1: 200 (100-300); Group 2: 37.5 (0-200); p < 0.001]. Conclusion Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907). Conclusion Preemptive RLB may be used to reduce patients' pain in lumbar decompression surgery as well as to be part of a multimodal analgesia and anesthesia regimen to reduce anesthetic and analgesic drug consumption. Trial registration numberClinicalTrials.gov (No. NCT04209907).Öğe The effects of preoperative reactions of emotional distress on headache and acute low back pain after spinal anesthesia: A prospective study(Pergamon-Elsevier Science Ltd, 2021) Peker, Kevser; Polat, ReyhanObjectives: To address the effect of preoperative symptoms of depression and anxiety on headache and low back pain after spinal anesthesia. Methods: This prospective observational cohort study included 370 patients who underwent spinal anesthesia before elective surgeries at a university hospital. The patients were evaluated in terms of symptoms of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Scale) while in their wards. The patients were evaluated via telephone calls for headache and low back pain after the operation. Results: Eighty-two (82/362) (23%) patients were determined as having headache and 28 (28/362) (7.8%) were determined as having low back pain. There was a significant association between preoperative depression scores and anxiety scores and VAS scores of headache (respectively, eta-squared = 0.19, p < .001; eta-squared = 0.14, p < .001). There was a significant association between preoperative depression scores and anxiety scores and VAS scores of low back pain (respectively, eta-squared = 0.02, p = .08; eta-squared = 0.03, p = .01). Conclusions: Preoperative symptoms of anxiety and symptoms of depression affect headache after spinal anesthesia. Preoperative symptoms of depression affect acute low back pain after spinal anesthesia. This trial was also registered at http://www.ClinicalTrials.gov. (Protocol Registration Receipt NCT03427372).Öğe The Wastage and Economic Effects of Anaesthetic Drugs and Consumables in the Operating Room(AVES, 2020) Peker, KevserObjective: Anaesthesia is a branch in which new anaesthetic drugs, devices, instruments and new treatment methods have been developed. Because of these innovations, health expenditures have escalated. Anaesthetic drugs and consumables constitute the majority of these expenses. Some waste of used drugs and consumables in the operating room is unavoidable. However, excessive drug wastage can be controlled. One of the ways to reduce the financial burden of this wastage is to know the loss cost. This study aimed to discuss the effect of the wastage of drugs and consumables. Methods: This prospective observational study was conducted in a hospital operating room over a six-week period. At the end of each operation and at the end of each operation day, the amount of wasted and consumables was recorded. The total wastage of the drugs and consumables was calculated by multiplying unit prices. Results: Data of 363 cases were collected during the study period. The total loss cost calculated during the study period was 2543.77 TL. The highest total loss cost was rocuronium (29.95%) and propofol (27.99%). The least loss was neostigmine (0.06%). The consumption rate of consumables was lower than that of drugs. Conclusion: A significant amount of drug wastage was recorded during the study period. This can be reduced by simple means. These applications vary from physician behavioural change to the preparation of standard doses of single-dose preparations. Cost training programmes at regular intervals can also be used as a cost-reduction strategy.
