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Öğe Comparison of morphine usage in intravenous PCA and epidural PCA(2003) To?al T.; Şahin Ş.; Durmuş M.; Türköz A.; Köro?lu A.; Ayas A.; Ersoy M.Ö.The aim of this study is to compare morphine for postoperative pain management by using intravenous and epidural patient controlled analgesia (PCA), for analgesic efficacy and side effects. After ethical committee approval was obtained, thirty cases aged 30-65 years (ASA I-II) were divided randomly into two groups. Group I received epidural PCA as loading dose morphine 2 mg, basal infusion rate 0.2 mg/h, bolus dose 0.5 mg and lockout time 30 minutes. Group II received intravenous PCA as loading dose morphine 5 mg, basal infusion rate 0.3 mg/h, bolus dose 1 mg and lockout time 15 minutes. Standard general anaesthesia procedure was performed. Procedure was started just after the operation. The mean arterial pressure, heart rate, respiratory rate, Visual Analogue Scale (VAS) and sedation scores were recorded at the end of the operation and at 1st, 2nd, 4th, 8th, 12th, 16th, 20th, 24th hour after the operation. Total morphine consumption, the number of request, the bolus dose delivery rate and side effects were recorded at the end of postoperative 24th hour. During 24 hours, morphine consumption and bolus dose delivery rate was significantly lower in Group I and the number of the request was significantly lower in Group II. There was no statistical difference between the two groups in terms of efficacy and VAS during 24 hours, except for the 8th hour. The VAS rates were below 3, after 8th hour in groups. VAS 8 score was lower in Group I. VAS rates at the hours 1, 2, 4, 8, 12, 16, 20, 24 decreased significantly compared to the rates at the beginning in each of the groups. Sedation scores at 1st, 2nd, 4th and 8th hour in Group I was lower than Group II. Pruritis was higher in Group I. There was no significant statistical difference between the two groups in terms of heart rate, mean arterial pressure and respiratory rate. As a result we conclude that the usage of morphine for the postoperative pain management by epidural or intravenous PCA provide effective analgesia only by short lock-out time and appropriate loading and bolus close.Öğe Comparison of the Fresh Gas Flows Adjusted to the Body Weights in Patients Undergoing Low Flow Anaesthesia Either with Isoflurane or Desflurane(2004) To?al T.; Ayas A.; Demirbilek S.; Gedik E.; Köro?lu A.; Karaaslan K.; Ersoy M.O.In this study, we aimed to examine the effects of fresh gas flow (FGF) adjusted to the body weight (10-20-30 mL kg-1 min-1) in patients undergoing low flow anesthesia either with isoflurane or desflurane on hemodynamics, body temperature, concentration of oxygen and anesthetic gases. Sixty ASA I-II adult patients undergoing elective surgical procedures were included into the study. Patients were randomly allocated into two basic groups to receive either isoflurane or desflurane. Then these basic groups were randomly divided into 3 sub-groups to receive 10, 20 or 30 mL k-1 min-1 FGF. After standard anesthetic induction and intubation, during the first 10 minutes, FGF was 4 L min-1 with isoflurane 1.5 % or desflurane 6 % in 50% oxygen and 50 % nitrous oxide. Then concentrations of isoflurane and desflurane were set as 2 % and 8 % respectively and FGF was adjusted according to the groups. Heart rate (HR), mean arterial pressure (MAP), SpO2, esophageal temperature, vaporizer settings, inspired and expired anesthetic concentrations were recorded at regular intervals throughout the study. Inspired and expired anesthetic concentrations were found to be decreased significantly in the 10 mL kg-1 min-1 flow groups when compared to the 20 and 30 mL kg-1 min-1 flow groups (p<0.05). The inspired oxygen concentration (FiO2) decreased parallel to the duration of anesthesia. Low FiO2 was observed in 2 cases in isoflurane group with 10 mL kg-1 min -1 flow and in 8 cases in desflurane group with 10 mL kg -1 min-1 flow (p<0.05). We concluded that, isoflurane and desflurane could be used safely with FGF of 10 and 20 mL kg-1 min-1 providing hemodynamic stability. However, there is was a risk of hypoxia in desflurane group with FGF of 10 mL kg-1 min -1. But, this can be prevented by increasing FiO2.Öğe Does the supplementation of fentanyl to bupivacaine affect unilateral spinal block?(2001) Durmuş M.; Türköz A.; To?al T.; Ayas A.; Öztürk E.; Ersoy M.O.The purpose of this study was to evaluate the affects of supplementation of fentanyl to rapid administered low dose hyperbaric bupivacaine for unilateral spinal anaesthesia in arthroscopic surgery. Thirty patients undergoing arthroscopic surgery were placed in the lateral position. After dural puncture (25-gauge Whitacre spinal needle), the needle hole was turned toward the dependent side and patients were randomly assigned to receive 7.5 mg of 0.5 % hyperbaric bupivacaine (Group I, n=15) or 7.5 mg of 0.5 % hiperbaric bupivacaine + 25 ?g fentanyl (Group II, n=15). Lateral and horizontal positions were maintained for 15 min before the patients were turned to supine position. Sensory block levels were assessed with three minutes intervals during lateral position and 5 minutes intervals during supine position and motor block levels were assessed with 15 minutes intervals. Spinal anaesthesia was unilateral in 80 % of group I and 13 % of group II at the end of the 15 min; after 60 min, spinal anaesthesia was unilateral in 80 % of group I and 0 % of group II (p<0.005). We conclude that fentanyl supplementation to low dose hyperbaric bupivacaine was disadvantageous in obtaining unilateral spinal anaesthesia although we can obtain long-term sensory block.Öğe The effects of irrigation fluid volume and irrigation time on fluid electrolyte balance and hemodynamics in percutaneous nephrolithotripsy(2003) Köro?lu A.; To?al T.; Çiçek M.; Kiliç S.; Ayas A.; Özcan M.Objective: to determine fluid-electrolyte and hemodynamics changes and complications associated with irrigation fluid volume and time in percutaneous nephrolithotripsy in that 0.9% NaCI was used as irrigant. Methods: Standard anaesthetic procedures were performed to 6 women and 16 men. Mean arterial pressure, heart rate, central venous pressure, Na+, K+, osmolality, haemoglobin, haematocrit were recorded before, during and after irrigation every 10 minutes. Creatinine and blood urea nitrogen were determined before and after irrigation. Moreover, the operation and irrigation times, irrigation fluid volume, total fluid output versus input, blood transfusions and complications were recorded. Results: Mean arterial pressure, heart rate, central venous pressure, Na+, K+, osmolality did not change significantly during and after irrigation and no relationship was observed between those with irrigation volume and time. Creatinine and blood urea nitrogen values during and after irrigation did not change significantly versus those before irrigation. Although no blood transfusion was needed for any case during the procedure, it was necessary for two cases after the procedure. One case with pneumothorax that developed during procedure was treated by inserting a thoracic tube. Conclusion: There were no significant changes in fluid-electrolyte balance and hemodynamics related to both irrigation fluid volume and irrigation time when 0.9% NaCI was used in PNL.Öğe Effects of Irrigation Fluid Volume and Irrigation Time on Fluid Electrolyte Balance and Hemodynamics in Percutaneous Nephrolithotripsy(2003) Köro?lu A.; To?al T.; Çiçek M.; Kiliç S.; Ayas A.; Ersoy M.Ö.This study was performed to determine fluid-electrolyte and hemodynamics changes and complications associated with irrigation fluid volume and irrigation time in percutaneous nephrolithotripsy (PNL) in which 0.9 % NaCl was used. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), Na+, K+, osmolality (Osm), haemoglobin, haematocrit values of 22 cases that were included into the study were recorded before, during and after irrigation every 10 minutes. Creatinine (Cre), blood urea nitrogen (BUN) were determined before and after irrigation. Moreover, operation and irrigation time, irrigation fluid volume, and complications were recorded. Mean time of operation and irrigation, irrigation fluid volume were determined 125.45 min, 69.40 min, 24.22 L, respectively. MAP, HR, CVP, Na +, K+, Osm did not significantly change during and after irrigation when compared to before irrigation. Fair degree of positive relationship was determined between irrigation fluid volume and Na+, CVP values after irrigation. Also significant positive relationship was determined between irrigation fluid volume and CVP during irrigation. Only significant positive relationship was determined between irrigation time and Na+ after irrigation. One case who developed pneumothorax developed during procedure was treated by inserting a thoracal tube. As a result, we established that there were no clinically significant changes in both fluid-electrolyte balance and hemodynamics related to irrigation fluid volume and irrigation time when 0.9 % NaCl was used in PNL. However we suggested that MAP, CVP, Na+ and Osm should be monitored closely when extensive amount of irrigation fluid volume and irrigation time were used.Öğe Effects of lntrathecal fentanyl in patients undergoing cesarean section(2000) Bakan N.; Ozpolat S.; Ayas A.; Ersoy M.O.In this study it is investigated the effects of fentanyl with intrathecal bupivacaine on 75 patients who underwent either elective or emergent cesarean sections. Patients were divided into three groups: Patients of Group I received 0.5 %, 2.5 mL bupivacaine; Group II received 0.5%, 2.5 mL bupivacaine+fentanyl 10 ?g and Group III received 0.5 %, 2.5 mL bupivacaine+fentanyl 15 ?g (per each group 25 patients), respectively. During procedure sistolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures, heart rate, peripheral oxygen saturation, motor and sensorial block levels, analgesic efficacy (duration of efficient analgesia, total amount of analgesic) were monitored. Decrements in SAP and MAP at 3rd and 5th minutes were statistically significant between groups (p<0.05). First ephedrin administration time was shortest in 15 ?g fentanyl group (Group I: 11.60±5.59 min; Group II: 8.15±5.58 min; Group III: 5.11±4.31 min) which was statistically different between groups (p<0.05). Motor and sensory block levels were higher in fentanyl groups. Motor block level values at 1st and 5th min and sensory block levels at 1st, 15th and 30th min were statistically significant when compared within groups (p<0.05). Three patients in Group I required additional analgesia and in another patient surgery was completed with general anaesthesia. None of the patients in Group H and III required additional analgesia. Analgesic efficacy was similar in all groups. Effects on newborns as monitored with umblical blood gas analysis and APGAR scores were all similar and within normal limits. There was no significant difference between the groups regarding side effects, but intraoperative nausea was less in fentanyl groups. In conclusion; addition of fentanyl to intrathecal bupivacaine in each group of patients was found to fasten the establishment of profound block, as well as decreases the necessity of intraoperative additional analgesia and also decreaes nausea, which were all more prominent in 15 ?g fentanyl group.
