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Öğe Anaesthesia for caesarean delivery in a pregnant with acute type B aortic dissection(2013) Kayhan G.E.; Gülhaş N.; Şahin T.; Özgül Ü.; Şanli M.; Durmuş M.; Ersoy M.Ö.About 50% of aortic dissections in women younger than 40 years occur during pregnancy; mostly in the 3rd trimester and postpartum period. Aortic dissection in pregnancy creates a serious mortality risk for both mother and the foetus. The ultimate goal is to ensure the safety of both the mother and the foetus. In such cases, the best method of anaesthesia for caesarean delivery is still controversial. The first aim of anaesthetic management is to reduce the effect of cardiovascular instability on the dissected aorta. Here, we report anaesthetic management of a 36 year-old patient who developed acute type B aortic dissection at the 30th gestational week and whom was scheduled for caesarean section. Since haemodynamic stability could not be achieved despite nitroglycerine and esmolol infusions, together with invasive arterial monitoring, the decision for caesarean delivery was taken. A team of Cardiovascular Surgeons and an operating room were prepared because of the risks of aortic rupture and haemodynamic collapse during operation. A combined-spinal epidural anaesthesia was administered using 5 mg hyperbaric bupivacaine and 20 ?g fentanyl given at the L3-4 spinal level in the lateral position. After achieving T4 sensorial level, the operation proceeded and a baby weighing 1432 grams was delivered in 4 mins with a median sub-umbilical incision. Epidural patient controlled analgesia was applied to the patient during follow-up with medical treatment at postoperative period. Application of combined-spinal epidural anaesthesia with a combination of low dose local anaesthetics and an opioid with additional doses for insufficient sensorial levels is a suitable method for pregnant women with acute type B aortic dissection. © 2013 by Turkish Anaesthesiology and Intensive Care Society.Öğe Anesthetic management of a patients with acute type A aortic dissection immediately after caesarean section(2012) Yücel A.; Gedik E.; Özgül Ü.; Erdo?an Kayhan G.; Koç E.; Erdil N.; Ersoy M.O.Acute aortic dissection is a disease which characterized by arterial wall separation, intimal dissection and hematoma. It has been seen half of dissections in women less than 40 yr of age occur during pregnancy, more commonly in the third trimester and postpartum period. Aortic dissection is a potentially risk factor for mother and baby during pregnancy. Ehlers-Danlos and Marfan's syndrome and number of pregnancy are associated with occurring of the aortic dissection. In this report, we discuss the management of anesthesia a patient with Marfanoid appearance who developed type A dissection of the aorta occurred 4 hours after elective Caeserean section.Öğe Anesthetic management of two patients with Cornelia de Lange syndrome(2012) Özgül Ü.; Begeç Z.; Yücel A.; Erdo?an M.A.; Bucak N.; Ersoy M.Ö.Cornelia de Lange syndrome is a rarely encountered disorder that is thought to progress secondary to hypoplasia of mesenchyma. Growth and mental retardation, hirsutism, major malformations of cardiac, gastrointestinal, and musculoskeletal systems with dysmorphic facial features are accompanied with this syndrome. Anesthetic management of these patients may encounter problems such as difficult tracheal intubation, aspiration and hypersensitivity to drugs. We want to review the anesthetic management and literature of the Cornelia de Lange Syndrome in this case presentation.Öğe Comparison of thoracic epidural vs paravertebral patient controlled analgesia after donor hepatectomy(2012) Koç E.; Toprak H.I.; Aslan S.; Özgül Ü.; Kizilyel C.; Ersoy M.ÖObjective: We aimed to compare thoracic epidural vs paravertebral blockade in terms of the relief of postoperative pain in donor hepatectomy. Material and Methods: 50 patients, aged 18-60 years, ASA I-II undergoing donor hepatectomy operation were enrolled in this study. Patients were randomly allocated into two groups of 25 patients each (Group 1, paraver-tebral analgesia; and Group 2, epidural analgesia) and either paravertebral or epidural analgesia was applied at the level of T6-8. Postoperative VAS, vital signs, sedation score, overall patients' satisfaction, cumulative consumption of local anesthetic, rescue analgesic requirements and side effects were evaluated for 24 hours after surgery. Results: Cumulative local anesthetic consumption in Group 1 was higher when compared with Group 2 at 2 and 4 hrs after surgery (p<0.05). In Group 1, rescue analgesic requirement was higher than in Group 2, but the difference was not statistically significant. There was no difference in patient satisfaction between groups. There were no complications except for nausea and vomiting in one patient within each group. Conclusion: Paravertebral analgesia may be a good alternative to thoracic epidural analgesia for postoperative pain control in patients undergoing donor hepatectomy.Öğe The Postoperative Analgesic Effects of Celecoxib and Rofecoxib in Total Abdominal Hysterectomy(2003) Durmuş M.; Köro?lu A.; Demirbilek S.; Özgül Ü.; Özcan Ersoy M.Celecoxib and rofecoxib that have been used in our country for treatment of osteoartritis and rheumatoid artritis are two COX-2 selective inhibitor non-steroidal antiinflammatory drugs. The aim of this study is to investigate postoperative analgesic and morphine sparing effects of single dose celecoxib or rofecoxib which were given before surgery in patients undergoing total abdominal hysterectomy. After obtaining approval from Ethics Committee, we studied 60 ASA I-II females undergoing total elective abdominal hysterectomy in a randomised, placebo controlled, double blind study. Patients were divided into 200 mg celecoxib (Group I, n=20), 50 mg rofecoxib (Group II, n=20) and placebo (Group III, n=20) groups. Anaesthesia was induced with 1.5 ?g kg -1 fentanyl, 4-6 mg kg-1 thiopental and 0.1 mg kg -1 vecuronyum. Morphine consumption, VAS scores at rest, on movement and on coughing and degree of sedation were evaluated during postoperative 2nd, 4th, 8th, 12th, and 24th h. Total morphine consumption was lesser in Group II at 8th h compared to Group III and at 12th and 24th h compared to Group I and III (p<0.05). VAS scores at rest, on coughing in Group I and II were significantly decreased during the first 24 h. There are no statistically significant differences between three groups regarding adverse effects. Although both celecoxib and rofecoxib produced a significant decrease in morphine consumption and VAS scores at rest, on movement and on coughing, we concluded that rofecoxib could produce better analgesia in early postoperative period and could decrease morphine consumption after 12th h with its long term effect.