Kamil Toker

• Professor
• Consultant at Kocaeli University

Objective: In the present study, the purpose was to investigate the effectiveness of cooling the vascular trace on pain caused by propofol and rocuronium injection. Methods: This prospective, single-blind study included 60 patients, aged 18-65 and scheduled for elective laparoscopic cholecystectomy. After vascular access was established with a 20 G...

Objectives and Aim: This study aimed to evaluate the impact of dexmedetomidine infusion dosage adjustment strategies guided by BIS and RSS on total consumption in patients undergoing infraumbilical surgeries under spinal anesthesia.Materials and Method: Eighty patients aged between 18-70 years, classified as American Society of Anesthesiologists (A...

Aims: In laparoscopic cholecystectomy surgery (LCS), for anesthesiologist and surgeons postoperative analgesia method is still problem. The aim of this study is to evaluate the effect of preoperative paravertebral block (PVB) application as a part of multimodal analgesia on postoperative pain management in this surgery. Methods: In this prospective...

Introduction Being prepared for difficult airway (DA) is nevertheless of great importance. Failed or delayed tracheal intubation (TI) can increase morbidity and mortality, and the pediatric population is more prone to hypoxia. With the development of different types of videolaryngoscope (VL), these have become the device of choice in patients with...

Objective The ProSeal laryngeal mask airway (PLMA) and I-gel, both second-generation supraglottic airway devices have been compared in previous studies but with inconsistent results regarding their safety and efficacy. Their influence on the hypopharyngeal mucosa have not been evaluated before under videolaryngoscopy. Methods One hundred ASA I-II...

Introduction This study aimed to examine the anesthesia practices applied to the cases during the pandemic, to analyze the rate of the precautions taken in emergency/elective operations in non-COVID patients, what precautions were taken, what resources the clinics had, and the patient management in the perioperative period by organizing a survey am...

The goal of the study was to evaluate the effectiveness of analgesia nociception index (ANI) monitoring during intraoperative period for patients with thoracic paravertebral block (TPVB) undergoing breast surgery under general anesthesia. This prospective randomized trial was performed after receiving ethics committee approval in 44 patients who we...

Objective: Endotracheal intubation should be performed with care when cervical spine (C-spine) injury is suspected. The aim of this study was to evaluate the movement of the C-spine using fluoroscopy during intubation with Laryngeal Mask Airway (LMA) CTrach, C-MAC videolaryngoscope and Macintosh laryngoscope. Methods: This was a single-centre, p...

In this study, we aimed to compare the effects of forced-air warming upper body blankets and forced-air warming underbody blankets on intraoperative hypothermia in patients who were planned to undergo open abdominal surgical operations in which extensive heat loss occurs. This prospective and randomized study included 92 patients who would undergo...

Background: Palpation of anatomic landmarks is difficult in pregnant patients due to physiological changes. This can complicate epidural catheterization and determination of needle insertion site to place an epidural catheter. The purpose of our study was to compare prepuncture lumbar ultrasonography and palpation method for epidural needle inserti...

Lumbar plexus block has been shown to be effective for providing postoperative analgesia after major hip surgeries in children. The goal of the study was to evaluate the feasibility of ultrasound guidance during lumbar plexus block in children undergoing hip surgery for congenital hip dislocation. After obtaining local institutional ethical committ...

Background: Spinal administration of dexmedetomidine has been proposed as an adjuvant in spinal anesthesia. However, there is limited information about its possible neurotoxic effect after its neuraxial administration. Potential spinal neurotoxicity should be investigated in animals before administering drugs through the spinal cord. Our aim was to...

Background/aim: Intubation must be rapidly performed with the utmost care in cervical trauma patients. We present the first comparison of GlideScope and an intubating laryngeal mask airway (ILMA) regarding insertion and intubation times, intubation success rates, mucosal damage, need for optimization maneuvers, effects on hemodynamic changes, and...

Objective: Glidescope and Airtraq were designed for facilitating intubation and for teaching regarding the airway anatomy. We aimed to evaluate their efficacy in normal airway, tongue oedema and face-to-face orotracheal intubation models when used by novice personnel. Methods: After the local human research ethics committee approval, 36 medical...

The author provides an overview of the history of optical instruments for airway management in anesthesiology. It systematically demonstrates the development of laryngoscope down to the present time when video laryngoscope has been introduced in clinical practice.

Objectives: Ultrasound-guided thoracic paravertebral block (TPVB) may be employed for postoperative analgesia in thoracic surgery. In application of TPVB, single injections, multiple injections or catheter techniques may be used. In this paper we present our experiences with ultrasound-guided TPVB in thoracic surgery patients for postoperative ana...

Airway management in emergency settings can be difficult due to limited access to the patient. The use of video laryngoscopes along with the Fastrach™ device improves tracheal intubation; however, the use of such devices in a face-to-face intubation model has not been evaluated in adult patients. After obtaining official approval from the Local Res...

Effective management of the airway is a priority in resuscitation efforts and a central issue in emergency medicine for providing ventilation and oxygenation in critically ill patients. Compared to the controlled conditions of the operating theatre, airway management in the emergency department is more difficult than in other circumstances; the pat...

Objectives: Obturator nerve block has been described and performed to prevent the obturator reflex during transurethral resection. Different techniques were found since then. We are using the interadductor approach in our clinic. We aimed to find out the outcomes of our practice in this study. Material Methods: After obtaining the ethical approv...

Thyroid surgery may cause severe postoperative pain and discomfort for patients. Superficial cervical plexus block (SCPB) is one of the regional anesthesia techniques that can provide postoperative analgesia for thyroid surgery. The purpose of this study was to evaluate analgesic effect of ultrasound (US) guided SCPB in patients undergoing thyroid...

A major advantage of ultrasound (US) has been reduction in the amount of local anaesthetic (LA) needed for successful blocks. Reduced LA requirement reduces the risk of LA toxicity when multiple blocks are to be done for surgery of more than one extremity in the same patient. The 38-year-old female was scheduled for elective surgery of polydactilia...

Preoperative care includes a clinical examination before invasive or non-invasive interventions for anaesthesia/analgesia and is the responsibility of the anaesthesiologists. Methemoglobinemia should be considered, as well as cardiac, pulmonary, and peripheral circulatory disorders in patients with central cyanosis and low oxygen saturation despite...

The videolaryngoscope is a useful alternative airway device for anaesthesia management of difficult airways. However videolaryngoscope intubation may fail due to lack of experience, incorrect application, inappropriate stylet, prior traumatic attempts, restricted cervical movement and limited oropharyngeal airspace. Using a stylet and correctly sha...

Objectives: Introduction of ultrasound into regional anesthesia (RA) practice has resulted in important changes and developments in RA. These developments have had a major influence on the way of practice and choice of blocks. The purpose of this study was to present the most recent instruments used in RA and clinical applications in our country....

http://bja.oxfordjournals.org/forum/topic/brjana_el%3B11671

Objective: Hypothermia is a common problem in anaesthetized patients and an important risk factor for mortality and morbidity. Our aim was to identify the incidence of hypothermia in our operating theatres. We also aimed to find the circumstances to which hypothermia could be related. Methods: After obtaining the ethics committee approval and in...

Supraglottic airway devices such as the LMA-Supreme (LMA-S) and I-gel, which have an additional lumen for the insertion of a gastric tube, can be useful in the management of the difficult airway. To test the performance of these two devices in the difficult paediatric airway, we compared the size 2 LMA-S with the I-gel in a simulated airway scenari...

The present study was conducted to examine if preinsertion lumbar ultrasound scanning helps with performance of spinal puncture, as a tool for decreasing the number of puncture attempts and spinal procedure time and increasing the success rate. We hypothesized that ultrasound can facilitate neuraxial blockade, particularly in pregnant women with di...

Serious neurological complications after neuraxial block, including permanent neurological injury, are rare in contemporary anesthetic practice. We report a case of a 36 year old female undergoing a venous stripping operation under combined spinal epidural anesthesia (CSE). The CSE procedure was completed after a second attempt at the L4-L5 level a...

Background: Pseudo-TORCH syndrome is a rare, chronic disorder that is characterised by dimorphic features such as microcephaly, intracranial calcification, seizures, mental retardation, hepatosplenomegaly and coagulation disorders. Case report: We present the anaesthetic management of a forty day-old boy with Pseudo-TORCH syndrome during magneti...

Supreme laryngeal mask airway (S-LMA) has been improved in recent years, but comparative studies with a sizeable number of paediatric patients are limited in number. In this study, oropharyngeal leak pressures (OLPs) were compared between S-LMA and ProSeal laryngeal mask airway (P-LMA) in paediatric patients. After obtaining approval from the ethic...

The aim of this study was to compare block performance time and secondarily success rates of coracoid block (CB) and lateral sagittal infraclavicular block (LSIB). This prospective study included 100 adult patients scheduled for upper limb surgery. Patients were randomly allocated to receive either a CB or LSIB. A local anesthetic mixture of 20 ml...

Arterial cannulation with ultrasound (US) guidance increases the success rate and reduces complications. US-guided vascular access has two main approaches: long axis in-plane (LA-IP) and short axis out-of-plane (SA-OOP) approaches. The purpose of this study was to compare performance time and possible complications between two techniques. After obt...

The traditional method to evaluate adequacy of the block for surgery is based on loss of sensory response to stimuli, which requires patient cooperation. Several methods have been described for objective assessment of the nerve block. The aim of the study was to investigate whether perfusion index (PI), a measure of peripheral perfusion from a puls...

Malignant hyperthermia (MH) is a rare, but life-threatining condition which is the hypermetabolic myopathy of skeleatal muscles triggered by the use of volatile agents or depolarizing muscle relaxants during general anesthesia. We aimed at presenting the clinical parameters which evoke suspicion of MH during general anesthesia by using sevofluran i...

Objectives: Ultrasound-guided supraclavicular and infraclavicular blocks are commonly used for upper extremity surgery. The primary aims of our study were to compare block success, block onset times and performance times; secondary aims were to compare the number of needle advancements, and incidence of adverse events of ultrasound-guided supracla...

Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. Material and methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pre...

Objective: Video laryngoscopy was developed to facilitate tracheal intubation of difficult airways. We aimed to compare the efficacy of CTrach™ (CT) and Direct Coupled Interface-Videolaryngoscope (DCI-VL) in patients with normal airways. Material and methods: Sixty ASA I-II (American Society of Anesthesiologists) adult patients admitted for elec...

Using low doses of local anesthetic, ultrasound guided multiple nerve blocks were performed in a high-risk patient. Surgical anesthesia was provided in an ASA III classified patient who received ultrasound guided right femoral and bilateral popliteal blocks. Using 80 mm needle, blocks were performed using a mixture of 10 ml 0.5% levobupivacaine and...

Using low doses of local anesthetic, ultrasound guided multiple nerve blocks were performed in a high-risk patient. Surgical anesthesia was provided in an ASA III classified patient who received ultrasound guided right femoral and bilateral popliteal blocks. Using 80 mm needle, blocks were performed using a mixture of 10 ml 0.5% levobupivacaine and...

The aim of this study was to evaluate the efficacy of the Intubating Laryngeal Mask Airway™ (ILMA) and Laryngeal Mask Airway CTrach™ (LMA CTrach) in facilitating tracheal intubation in morbidly obese patients. Eighty patients (body mass index >40 kg x m(-2)) were randomly allocated to the ILMA or the LMA CTrach. The median (IQR [range]) total time...

Endoscopic third ventriculostomy (ETV) is currently considered the best alternative to shunt systems in the treatment of triventricular hydrocephalus. However, there has been very few published data about the anaesthetic management and the complications of ETV procedure in infants. In this report, we detail our experience with 57 infants, who under...

VACTERL syndrome can prone problems for an anesthesia due to multiple anomalies. In this case report, we aimed to share our anesthetic experiences about the case of a newborn diagnosed VACTERL syndrome after birth and undergone oesophageal atresia and tracheo-oesophageal fistula repair.

Objective: Propofol is an anesthetic agent used frequently for the induction and maintenance of anesthesia, and sedation as well. Its most important side effects are injection pain, and hemodynamic side-effects. There are reports stating that with a new formula (Propofol-Lipuro) injection pain is reduced. In our study the effects of sub-anesthetic...

Objective: Laryngeal mask airway (LMA) has been used to secure the airway in pediatric patients and its safety and effcacy has been shown in several large-scale studies. A new LMA with a gastric drainage tube ie. Proseal LMA was introduced in 2000 with the intention of providing a more secure airway for airway management. In this study, we compared...

Aim: We investigated the impact of anesthetic depth by bispectral index (BIS) monitorization on anesthetic drug usage, eye opening and extubation time after anesthesia on patients who are undergoing transsphenoidal hypophysectomy under general anesthesia. Material and Method: After approval of Kocaeli University Ethics Committee 60 ASA II-III patie...

We aimed to evaluate differences in the interobserver reliability and accuracy of sequential organ failure assessment (SOFA) scoring between nurses and residents. Eight nurses and eight residents independently scored 24 randomly selected patients. Intraclass correlation coefficients (ICCs) for the reliability of total SOFA scoring were calculated....

Tricyclic antidepressants are among the drugs most frequently involved in pediatric exposures. We report here a case of a fatality in a 2.5-year-old boy after he ingested an overdose of amitriptyline . He developed seizure, hypotension, and his pupils became dilated which were interpreted as signs of TCA overdosages at first. However, his serum Na...

In this prospective, placebo-controlled study, we evaluated the effect of prophylactic ondansetron therapy on emergence agitation of children who underwent minor surgery below the umbilicus. Seventy children aged one to six years and American Society of Anesthesiologists physical status I were studied. Children were premedicated with midazolam rect...

To evaluate the frequency of respiratory adverse events during general anesthesia in children passively exposed to cigarette smoke (PSE). Prospective, double blinded, observational study. Operating room and recovery room of a university hospital. Data were collected from 385 children who underwent elective surgery during general anesthesia from Jun...

Objective: Subarachnoid blocks have become the technique of choice for elective cesarean sections. Current techniques to identfy a safe interspace have limitations. In this study, we assessed prepuncture lumbar ultrasound scanning as a tool for estimating the depth to the subdural space and determining the optimal insertion point in parturients. Me...

The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. The aim of this study was to compare the airway management quality in morbidly obese and lean patients with use of the LMA CTrach. After Ethics Committee approval, 60 adult patients (30 morbidly obese patients with body mass index >40 kg/m² and 30...

Objective: The aim of the study was to investigate the incidence of postoperative residual curarization (PORC) after rocuronium administration using normalized acceleromyographic (AMG) train-of-four (TOF) ratios. Material and Methods: During propofol-fentanyl-nitrous oxide anesthesia, neuromuscular block was monitored using acceleromyography method...

The aim of our study was to compare classic laryngeal mask airway (LMA-C) with the endotracheal tube (ETT) in pediatric laparoscopic surgery to evaluate the intragastric pressures (IGP) using intragastric pressure monitoring. We also sought to investigate the related influence on respiratory parameters. The Ethics Committee of the Health Institutio...

When ultrasound (US) is used in peripheric nerve blocks, successful nerve blocks can be performed even if nerve stimulation is not possible. In this case report, we present a 37-year-old male patient, ASA physical status I, undergoing debridement and grafting for incomplete arm whose upper extremity (forearm) was amputated due to electric shock; mo...

The objective of the study was to evaluate the influence of ultrasound (US) guidance alone vs. neurostimulation (NS) and US (NSUS) guidance techniques on block performance time and block success rate for the lateral sagittal infraclavicular block (LSIB). In a randomized and prospective manner, 110 adult patients scheduled for distal upper limb surg...

The aim of this prospective study was to compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.125% or caudal tramadol 1.5 mg.kg(-1) and mixture of both in children undergoing day-case surgery. Sixty-three American Society of Anesthesiologists (ASA) I or II children between 1 and 7 years old scheduled...

Sepsis is a common cause of acute renal failure in intensive care units (ICU) with mortality rates as high as 60%. In this study, the clinical and laboratory predictors of acute kidney injury (AKI) in critically ill Turkish patients with sepsis/systemic inflammatory response syndrome were identified. We studied 139 (67 females/72 males) patients ad...

Aim: The aim of this study was to compare in pediatric patients adverse effects, sedative efficacies, and also recovery rates of propofol and ketamine used for magnetic resonance imaging. Material and Method: Hundred and two children aged 6-60 mos were randomly assigned into two groups (ketamine and propofol). After rectal application of 0,6 mg kg...

Bilateral brachial plexus block is rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in bilateral extremity operations. However, usage of ultrasound allows easy visualization of the structures of the vessels and the nerves. In this case report, we present a 28-year-old m...

The aim of this study was to evaluate the effectiveness of the Airtraq and CTrach in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaest...

We studied the influence of patient positioning on the visibility of the sciatic nerve during ultrasound (US) examination in the popliteal region. Using a linear broad band 7-12 MHz frequency probe, US examination of 24 sciatic nerves was performed by a blinded operator to obtain the best possible image at the level of the popliteal crease (PC) and...

The objective of this study was to evaluate the influence of single vs. dual control during an ultrasound-guided lateral sagittal infraclavicular block on the efficacy of sensory block and the time of block onset. In a prospective manner, 60 adult patients scheduled for distal upper limb surgery were randomly allocated to single (Group S) or double...

The LMA-Supreme() (S-LMA()) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA-Proseal() (P-LMA()) and S-LMA(). Sixty adult patients were prospectively and randomly a...

Congenital anomalies in the tracheobronchial tree structure can lead to various respiratory problems during anesthesia. Tracheal bronchus is a congenial anomaly of the tracheobronchial tree structure; it is mislocalized in the tracheal bronchus orifice or at the superiority of the bifurcation of trachea or accessory bronchi may have developed. Endo...

Objectives: Parasternal block to provide postoperative analgesia in open heart surgery was first described by McDonald et al (1). They used levobupivacaine as a local anesthetic in their placebo controlled study and showed that parasternal block reduced postoperative opioid consumption. The aim of our study was to compare the postoperative analgesi...

The aim of the study was to investigate the effects of adding intrathecal magnesium sulfate 50 mg to low-dose bupivacaine-fentanyl on the spread, duration, regression of spinal block, and postoperative analgesia in patients undergoing knee arthroscopy. This study was designed in a prospective, randomized, and double-blinded manner. Sixty American S...

Ultrasound may provide effective guidance during nerve blocks in cases where nerve stimulation is not feasible for various reasons. We describe a 28-year-old, ASA physical status I, male patient who was operated for pectoral flap release under lateral sagittal infraclavicular block. Using ultrasound guidance alone, total volume of 30 ml of local an...

Recent advances in surgical techniques for thoracic have led to an increased use of one lung ventilation techniques. One lung ventilation is performed by doubled lumen tubes, fogarty catheters, Univent tubes and bronchial blockers. In this paper our bronchial blocker experiences were presented in fifteen thoracic surgery patients. Bronchial blocker...

Tracheal bronchus is a congenital anomaly in which the right upper lobe bronchus originates from the lateral wall of the trachea. During conventional endotracheal intubation, the distal side of tracheal tube can obstruct the congenital bronchus. This may lead to right upper lobe atelectasis and/or hypoxemia. Tracheal bronchus has a prevalence of 0....

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease of unknown cause that predominantly affects females between the ages of 20 and 50 years, but is reported in all age groups. In this case report, we aimed to share our experience of anesthesia which is about a pregnant emergency cesarean section indication breech presentat...

Horner's Syndrome results from paralysis of the ipsilateral sympathetic cervical chain (stellate ganglion) caused by surgery, drugs (mainly high concentrations of local anesthetics), local compression (hematoma or tumor), or inadequate perioperative positioning of the patient. It occurs in 100 % of the patients with an interscalene block of the bra...

A nerve stimulation-guided lateral sagittal infraclavicular block (LSIB) has been proven to be an effective block. The purpose of this study was to evaluate whether the use of ultrasound (US) guidance would further improve the block quality of LSIB. In a prospective manner, 80 adult patients scheduled for hand, wrist and forearm surgery were random...

The purpose of this study was to evaluate the clinical utility and block success rate of 'lateral sagittal infraclavicular block (LSIB)' in a large-scale clinical study. Adult patients scheduled for hand, wrist and forearm surgery between March 2005 and June 2007 were prospectively included into the study. Using a nerve stimulator LSIB was performe...

Stiff leg syndrome (SLS) is considered as a focal form of stiff person syndrome (SPS) in which symptoms are confined to a distal limb. A patient with stiff leg syndrome developed a malignant neuroleptic syndrome (NMS) after having been treated with a single dose of haloperidol. She developed renal failure and disseminated intravascular coagulation,...

Preoperative evaluation is important in the detection of patients at risk for difficult airway management. It is still unclear whether true prediction is possible and which variables should be chosen for evaluation. The aim of this prospective, multi-centre study was to investigate the incidence of difficult intubation, the sensitivity and positive...

We evaluated the duration of analgesia, side effects and neonatal effects of intrathecal ropivacaine combined with two different doses of morphine using combined spinal epidural (CSE) technique for labour analgesia. Fourty term parturients were enrolled. Group I received 0,2% ropivacaine 3 mg + morphine 50 microg and Group II received 0,2% ropivaca...

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