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    Bedside ultrasonography for the confirmation of gastric tube placement in the neonate
    (Wolters Kluwer Medknow Publications, 2019) Atalay, Yunus Oktay; Polat, Ahmet Veysel; Özyazıcı Özkan, Elif; Tomak, Leman; Aygün, Canan; Tobias, Joseph Drew
    Background: Naso/Orogastric tube (NOGT) misplacement can lead to significant complications. Therefore, the assessment of tube position is essential to ensure patient safety. Although radiography is considered the gold standard for determining NOGT location, new methods may be helpful in reducing repetitive radiation exposure, especially for neonates. In this study, we sought to investigate if bedside ultrasonography (BUSG) can be used to verify NOGT placement in neonatal intensive care patients. Materials and Methods: Infants requiring NOGT placement were enrolled. After insertion of the NOGT, the location was first identified using BUSG and then confirmed using abdominal radiography for comparison. Results: The study cohort included 51 infants with an average gestational age of 34 +/- 4.9 weeks. BUSG determined the NOGT location correctly with a sensitivity of 92.2%. The location of the NOGT could not be determined by BUSG in four neonates (7.8%). In one infant, the NOGT was positioned in the esophagus, as determined both by BUSG and radiography. Conclusion: BUSG is a promising diagnostic tool for determining NOGT location in neonates, thereby eliminating the need for abdominal radiography.
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    Liver transplantation in a child with kartagener syndrome: A case report
    (Dove Medical Press Ltd, 2021) Uludağ Yanaral, Tümay; Karaaslan, Pelin; Uzunoğlu, Emine; Atalay, Yunus Oktay; Tobias, Joseph Drew
    Background: Kartagener syndrome (KS) is a rare genetic disorder consisting of the triad of situs inversus, chronic sinusitis, and bronchiectasis. Although there are previous reports regarding the anaesthetic considerations in KS, none have included liver transplantation. Case Presentation: An 11-year-old boy with a diagnosis of KS underwent liver transplantation due to extrahepatic biliary atresia. Previous diagnostic imaging confirmed situs inversus and the absence of an inferior vena cava. The patient's peak airway pressure intermittently increased intraoperatively from 15 to 30 cm H2O due to increased pulmonary secretions, which required frequent suctioning of the endotracheal tube. Intraoperative volume resuscitation included 200 mL of 5% albumin, 5 units of erythrocyte suspension and 3 units of fresh frozen plasma. Intermittently, a norepinephrine infusion was required to maintain the MAP. Coagulation function was monitoring using the thromboelastogram to guide the use of blood products including fresh frozen plasma. At the end of the surgery, the patient was transferred to the intensive care unit. He was discharged from the intensive care unit on postoperative day 5, and from the hospital on postoperative day 28. He continues to do well with normal liver function 23 months after surgery. Conclusion: Despite the risk of pulmonary related to airway secretions and exacerbation of hemodynamic instability related to anatomical variations in the inferior vena cava anatomy, KS patients can be safely anesthetized with careful planning and attention of the disease process, even for complex surgical procedures such as liver transplantation.
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    Rhinorrhea due to infusion of dexmecetomidine during rhinoplasty: A case report and current literature review
    (Galenos Publishing, 2022) Uludağ Yanaral, Tümay; Karaaslan, Pelin; Güngör, Hande; Atalay, Yunus Oktay; Tobias, Joseph Drew
    Dexmedetomidine can be used to achieve controlled hypotension during surgery. A 26-year-old female with no medical history underwent rhinoplasty. The maintenance of the anesthesia was achieved with propofol and dexmedetomidine (1 mcg kg-1 as a loading dose for 10 minutes, followed by 0.5 mcg kg-1 hr-1 as maintenance) infusion as total intravenous anesthesia. Propofol and dexmedetomidine infusion doses were adjusted to maintain a bispectral index of 40-60 and a mean arterial pressure of 55-65 mmHg. During surgery, rhinorrhea developed, which disrupted the view of the surgical field. An intravenous antihistamine and a topical decongestant were administered. However, rhinorrhea persisted, suggesting that it developed as a drug-related adverse effect. Dexmedetomidine was halted. Subsequently, the rhinorrhea decreased, and the quality of the surgical field improved. That was a temporary and reversible side effect, which resulted in no long-term sequela. To the best of our knowledge, this is the first patient who developed rhinorrhea as a side effect of dexmedetomidine infusion during rhinoplasty.