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Öğe Comments on "Local Anesthetic Systemic Toxicity"(OXFORD UNIV PRESS INC, 2016) Onal, Ozkan; Saltali, Ali Ozgul; Apiliogullari, Seza[Abstract not Available]Öğe Relationship between the Right Internal Jugular Vein and Carotid Artery at Ipsilateral Head Rotation(TAYLOR & FRANCIS LTD, 2013) Ozbek, Seda; Apiliogullari, Seza; Kivrak, Ali Sami; Kara, Inci; Saltali, Ali OzgulUltrasound-guided right internal jugular vein catheterization (RIJV) should be the first choice to decrease the catheter-related complications in high-risk hemodialysis patients. For this procedure, clinicians should identify the optimum positions of the RIJV, including its lower overlap with the carotid artery (CA) and high cross-sectional area of the vein. The aim of this prospective randomized study to evaluate the effects of mild ipsilateral head rotation combined with Trendelenburg position on RIJV cross-sectional area and its relation to the CA in adult patients. Forty ASA I-II patients who were undergoing elective surgery were enrolled for this study. The subjects were asked to remain supine in the 15-20 degrees Trendelenburg position. Two-dimensional ultrasound was then used to measure the degree of overlap between the RIJV and CA, the cross-sectional area of the RIJV. These measurements were compared between head rotation to the >30 degrees left, <30 degrees left, neutral, and <30 degrees right positions. When the head was in the >30 degrees left position, overlap was seen in 38 of 40 patients (95%). As the head was rotated from >30 degrees left to <30 degrees right, the CA-RIJV overlap (from 95% to 57.5%), and the cross-sectional area (from 14.2 mm to 8.7 mm) significantly decreased. In conclusion, when the head was turned to <30 degrees right, the CA-RIJV overlap significantly decreased, and the cross-sectional area also decreased. When clinicians determine the optimal head position before RIJV cannulation, it is important to consider the advantages and disadvantages of the different head positions from >30 degrees left to <30 degrees right.Öğe Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients(TAYLOR & FRANCIS LTD, 2015) Nayman, Alaaddin; Onal, Ibrahim Ozkan; Apiliogullari, Seza; Ozbek, Seda; Saltali, Ali Ozgul; Celik, Jale Bengi; Temizoz, OsmanBackground and aim: Trendelenburg positioning (TP) is a common approach used during internal jugular vein (IJV) cannulation. No evidence indicates that TP significantly increases the cross-sectional area (CSA) of the IJV or decreases the overlap between the carotid artery (CA) and the IJV in dialysis patients. The primary aim of this study was to investigate the effects of the TP on the CSA of the right IJV and on its relationship to the CA. Methods: Thirty-seven consecutive hemodialysis patients older than 18 years of age were enrolled. We measured the CSA of the right IJV and overlap rate (at end-expiration at the level of the cricoid cartilage) between the CA and the IJV in two positions: State 0, table flat (no tilt), with the patient in the supine position; State T, in which the operating table was tilted to 15 degrees of TP. Results: Data were collected for all of the 37 patients enrolled in the study. The change in CSA and overlap between the CA and the IJV from the supine to the TP was not significantly different. The CSA was paradoxically decreased in 11 of 37 patients when changed from State 0 to State T. Conclusions: TP does not significantly increase the CSA of the right IJV or decrease the overlap between the CA and the IJV in dialysis patients. In fact, in some patients, it reduces the CSA. Therefore, the use of the TP for IJV cannulation in dialysis patients can no longer be supported.
