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    Does laparoscopic-guided transversus abdominis plane block have an effect on postoperative pain and recovery after sleeve gastrectomy?
    (Verduci Publisher, 2022) Okut, G.; Turgut, E.; Kaplan, K.; Bag, Y. M.; Akbas, S.; Sumer, F.; Kayaalp, C.
    - OBJECTIVE: Postoperative pain management is thought to have an effect on pa-tient comfort, morbidity, and mortality after bar-iatric surgery. Local anesthetic agents are fre-quently used for this purpose. Local anesthetics can be used in many different ways. In this study, we aimed to investigate the effect of transversus abdominis plane (TAP) block on postoperative pain by laparoscopic method.PATIENTS AND METHODS: A prospective randomized clinical trial was performed. While TAP block was applied to one group with bupiv-acaine, no action was taken for the other group. Postoperative analgesia was given to both pa-tient groups with the patient-controlled anal-gesia (PCA) device. Demographic, operational, and postoperative clinical and pain data of the patients were recorded. RESULTS: TAP block and non-TAP block groups consisted of 30 patients each. Visual analog scale (VAS) scores of the patients at 6, 12, and 24 hours were lower in the TAP group compared to the non -TAP group (p=0.015, 0.018, 0.04, respectively). Ac-cording to the PCA device data, the analgesic re-quirement was lower in the TAP group at 6, 12, and 24 hours (p <0.001). Rescue analgesia was re-quired more in the non-TAP group (p=0.04). There was no statistically significant difference between the two groups in terms of gas discharge time (p=0.102), stool discharge occurred earlier in the TAP group (p=0.02). Oral intake times (p=0.554) and length of stay hospital (p=0.551) were similar.CONCLUSIONS: Laparoscopic TAP block us-ing bupivacaine can be safely administered in morbidly obese patients and reduces postoper-ative analgesic requirements. Thus, side effects that may develop secondary to the use of anal-gesics are avoided.
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    Efficacy of Intravenous Paracetamol and Ibuprofen on Postoperative Pain and Morphine Consumption in Lumbar Disc Surgery: Prospective, Randomized, Double-Blind, Placebo-Controlled Clinical Trial
    (Masson Editeur, 2021) Akbas, S.; Ozkan, A. S.; Durak, M. A.; Yologlu, S.
    Objectives. - Effective postoperative pain management after lumbar disc surgery reduces complications and improves postoperative care. The purpose of this prospective, randomized, double-blind, placebo-controlled clinical study is to evaluate the effects of IV paracetamol and ibuprofen on postoperative pain, morphine consumption and side effects of morphine in patients who underwent lumbar disc surgery. Materials and methods. - Seventy-five patients aged 18-85 years scheduled for lumbar disk surgery with a single level laminectomy included in this study. All patients received morphine with an IV patient-controlled analgesia device during the first postoperative 24 hour. The patients were divided randomly and double-blinded into three groups (control, paracetamol and ibuprofen). The demographic characteristics and procedure data, VAS score, cumulative morphine consumption, opioid-related side effects were recorded. Results. - There was no significant difference regarding to demographic characteristics, comorbidities, and durations of anesthesia and surgery. There was a significant difference between all groups regarding to total morphine consumption (P< 0.001). IV ibuprofen significantly reduced the total morphine consumption in comparison with control and paracetamol (P< 0.001). Repeated measures ANOVA showed in all periods of the study that VAS score was significantly lower in ibuprofen (P < 0.001), but not in paracetamol (P= 0.394) in comparison with control. There was no difference between groups regarding postoperative heart rate, mean arterial pressure, nausea-vomiting, pruritus and urinary retention. Conclusions. - This study showed that pain scores and morphine consumption, but not the side effects of patient-controlled analgesia during 24 hours after the lumbar disk surgery, were significantly reduced by IV ibuprofen as a supplemental analgesic when compared with controls and paracetamols. (C) 2021 Elsevier Masson SAS. All rights reserved.
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    Nasotracheal Intubation in Children for Outpatient Dental Surgery: Is Fiberoptic Bronchoscopy Useful
    (Medknow Publications & Media Pvt Ltd, 2018) Ozkan, A. S.; Akbas, S.
    Background: The aim of our study was to compare the hemodynamic responses and adverse events associated with nasotracheal intubation (NTI) using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS) in children undergoing general anesthesia for outpatient dental surgery. Methods: Eighty children (aged 5u15 years) were scheduled to undergo outpatient dental surgery under general anesthesia and of these children those who required NTI were included. Results: NTI was significantly longer in the FOB group (P = 0.03). In both groups, systolic blood pressure (SBP) and heart rate (HR) significantly decreased after the induction of anesthesia when compared with the baseline values. SBP was significantly higher in both groups at intubation and 1 and 3 min after intubation when compared with postinduction. SBP significantly increased in the DLS group compared with the FOB group at intubation and 1 min after intubation. HR was significantly increased at intubation and 1 min after intubation in the DLS group compared with the FOB group. Nose bleeding after intubation was significantly more frequent in the DLS group (30%) than in the FOB group (7.5%) (P = 0.034). The incidence of sore throat 24 h after surgery was 20% (8/40) in the DLS group and 2.5% (1/40) in the FOB group (P = 0.014). Conclusions: There are fewer hemodynamic responses and adverse events in the FOB group than in the DLS group; therefore, FOB can be safely used for NTI in children undergoing outpatient dental surgery, and FOB may be more successful than DLS for NTI.
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    pH-sensitive chitosan-PEG-decorated hollow mesoporous silica nanoparticles could be an effective treatment for acute myeloid leukemia (AML)
    (Springer, 2022) Ultav, G.; Tonbul, H.; Tavukcuoglu, E.; Ozturk, S. C.; Akbas, S.; Sahin, A.; Esendagli, G.
    Improved treatment of acute myeloid leukemia (AML) could be possible by longer retention of anticancer drugs in the bloodstream. In this study, it was aimed to obtain improved treatment against AML by providing prolonged blood levels of doxorubicin and ensuring endosomal escape by the proton sponge effect. With this aim, pH-sensitive and chitosan-poly ethylene glycol (Cs-PEG) coated doxorubicin-loaded hollow mesoporous silica nanoparticles (C-HMSN-DN) were prepared. Nanoparticles (NPs) were characterized by dynamic light scattering (DLS), zeta potential, transmission electron microscopy (TEM), X-Ray diffraction (XRD), and nitrogen adsorption-desorption isotherms. High doxorubicin encapsulation efficacy was obtained as 90%. pH-sensitive formulations were showed higher cellular uptake and found more effective against human leukemia cell line (HL60) than non-pH sensitive formulations. In vivo studies showed that Cs-PEG coating prolonged blood circulation time tremendously in comparison to unmodified nanoparticles and free doxorubicin. The designed drug delivery system (DDS) can be more effective by endosomal escape to eliminate myeloid cells which are granular cells containing a great number of lysosomes. In conclusion, we present a drug delivery system that provides a prolonged blood circulation time due to Cs-PEG coating and effective drug delivery via pH-sensitive drug release and endosomal escape for AML treatment.