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Öğe Anesthetic management of a patient with sirenomelia: A case report(AVES, 2012) Yücel A.; Begeç Z.; Erdo?an M.A.; Konur H.; Ergin H.; Ersoy M.O.Sirenomelia or mermaid syndrome is an extremely rare developmental malformation characterized by complete or partial hipotrophy or fusion of the lower limbs. Gastrointestinal and urogenital anomalies are often accompanies with this congenital syndrome. Difficulty in determining the location of the peripheral veins and abnormal venous drainage may limit the use of limb for intravenous access. Associated anomalies should be identified and measures should be taken during the preoperative period. In this report we discussed anesthetic management of a patient diagnosed as sirenomelia syndrome.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 Anesthetical approach in a patient undergoing beating heart coronary artery bypass surgery with adrenal insufficiency(Turkish Anaesthesiology and Intensive Care Society, 2008) Erdil F.; Begeç Z.; Öztürk E.; But A.K.; Nisano?lu V.; Ersoy M.Ö.Glucocorticoids were released with a high amount from adrenal cortex in physiological and surgical stress situations to supply homeostasis. But the patients who had adrenal insufficiency, as a result of anesthesia and surgical stress or the insufficiency in glucocorticoid treatment, life threating adrenal crisis can exist. In this case report, we discuss the successful anesthesia technique and cortisol treatment in a patient who underwent beating heart coronary artery bypass surgery with bilateral adrenalectomy surgery for Cushing Syndrome and who have been taken glucocorticoid treatment for several years.Öğe Antibacterial effectiveness of alkalinized ropivacaine and bupivacaine(2007) Begeç Z.; Gülhaş N.; Toprak H.I.; Erdil F.; Yetkin G.; Özean Ersoy M.Aim: We aimed to investigate the antibacterial effects of alkalinized ropivacaine and bupivacaine on the Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa Materials and Methods: In this study, solutions of bupivacaine 0.5%, ropivaeaine 0.2%, bupivakain 0.5%+NaHCO3, ropivakain 0.2%+NaHCO3 with bactorial cultures' E. coli, S. aureus and P. aeruginosa were used. Bacteria were grown on standard blood agar. Bacterial cultures were prepared in a density of 0.5 McFarlands units (10 8 efu ml-1) with sterile saline 0.9% and each bacterial solution was further diluted in Mueller-Hinton broth to obtain standard inocula (105 cfu ml-1). The tested solutions (2 ml) and controls (2 ml, physiological saline) were added to 2 ml of standard bacterial preparations. Aliquats (3 ml) were vortexed and pipetted into sterile polystyrene spectrophotometer cuvets and it was incubated at 37°C. The optical density at 540 nm was measured at 0, 3 and 6 h by spectrophotometer. Results: While hupivacaine inhibited the growth of S. aureus and E. coli at all measurements times, P. aeruginosa inhibited at only 6 h (p<0.05). Alkalinized bupivacaine inhibited the growth of S. aureus at 0 h and E. coli at 0 and 6 h (p<0.05). Antibacterial effects of hupivacaine on E. coli was significantly higher than alkalinized bupivacaine at 6h (p<0.05). While ropivaeaine more inhibited the growth of S. aureus at 0 and 3 h than alkalinized ropivauaine, alkalinized ropivacaine less inhibited it according to the control (p<0.05). While both ropivacainc and alkalinized ropivakain inhibited the growth of E. coli at 3 and 6 h, at 0 h only ropivacaine inhibited it (p<0.05). Ropivacaine and alkalinized ropivaeaine inhibited the growth of P. aeruginosa at 3 h (p<0.05). Conclusion: It has been determined that bupivacaine has antibacterial effect and alkalinization of bupivacaine does not change it, ropivacaine has poor antibacterial effect and it more reduced with alkalinization of ropivacaine.Öğe Caudal block in paediatric surgery: A retrospective survey in 2262 patients(2005) Begeç Z.; Durmuş M.; Toprak H.I.; Köro?lu A.; Ülger H.; Ersoy M.Ö.; Özpolat Z.Aim: The caudal block is a common regional anaesthetic techniques in infant and children. Limited data regard complications have been reported. We reviewed the anaesthesia records of 2262 paediatric patients in whom caudal block was performed between June 1995-May 2004 in our institution and describe the associated morbidity and complications. Results: Anaesthesia was induced with inhalation agents in 1633 patients, and intravenous agents in 629 patients. Caudal blocks were obtained by administering 1 mL kg-1 of 0.25% bupivacaine in 1563 patients, 0.25% bupivacaine and 1% prilocaine in 400 patients, 0.25% bupivacaine and 0.5 mg kg-1 ketamine in 61 patients, 0.25% bupivacaine and 1 mg kg-1 fentanil in 106 patients, and 0.2% ropivacaine in 132 patients. Complications rates were not different between patients over 10 kg and ?10 kg. There were statistically significant differences regarding total complications, and subcutaneous infiltration and intravenous injection rates comparing 1-2 years residents with 2-3 years and 3-4 years residents and staff anaesthesiologists (p<0.05). Conclusion: We conclude that caudal block is an appropriate technique in paediatric patients scheduled for surgery below the umbilicus. Complication rates decrease after the first year of aneasthesia training.Öğe The effect of body-mass index on the duration of spinal anesthesia(AVES İbrahim KARA, 2006) Gülhaş N.; Begeç Z.; Durmuş M.; Erdem T.B.; Yücel A.; Ersoy M.Ö.Aim: The purpose of our study was to examine the duration of spinal anaesthesia obtained with same volume of local anesthetics in patients who have different bodymass index (BMI). Materials and Methods: After the approval from the faculty ethical committee and patient informed consent, 90 patient (ASA I-II, 15-65 years-old) who have undergoing elective urological surgery were included in to the study. Patients had normal body weight (BMI= 20-25), excessive body weight (BMI- 25-30) and obese patients (BMI= 30-35) were divided in N, EW (Excessive weight) and O groups, respectively. Spinal block was achieved by 3 mL hyperbaric bupivacaine with a 25 G Quincke spinal needle through L4-L5. Following the spinal block, maximum sensory block level, the periods to reaching the maximum sensory block, to decline of the sensory block at two levels, the time of the motor block relief were recorded in each patient in two minutes intervals. Results: The time to two level decline of sensory block and the time of the motor block relief were longer significantly in Group EW and O than Group N (p<0.05). Although motor block relief time was similar between group EW and O, there was a significant difference between these groups regarding to two level declining time (p<0.05). 2nd and 4 th minute Bromage scores were higher in Group O than Group N and Group EW (p<0.05) Conclusion: We considered that the duration of the spinal anaesthesia obtained with same volume of local anaesthetics were lengthened parallel to BMI.Öğe Effect of inhalation anesthesia in postoperative atrial fibrillation after coronary artery bypass surgery(2009) Erdil F.; Begeç Z.; Öztürk E.; But A.K.; Gedik E.; Ersoy M.Ö.Atrial fibrillation (AF) is an important rhytm problem which occurs in the ratio of 10-50 % after CABP. It is shown that the inhalation anaesthetics have important role on protection of cardiac function in the early postoperative period. The purpose of this study is searching the effects of the inhalation agents retrospectively on the frequency of AF which occur after CABG in the early postoperative period. Patients were assigned into three groups as isoflurane (Group I; n=260), sevoflurane (Group S; n=308) and desflurane (Group D; n=349) according to the inhalation anaesthetic administered. Continue ECG monitorization was performed to each patients who was hospitalizated in intensive care unit. Routine ECG monitorization was performed to the patients at just after the operation and in the postoperative 1st., 2nd. and 4th. days. The rhythm controls were assessed by the assistant doctors by palpitation of radial artery four times a day at service controls. ECG monitorization was performed to the suspected patients except this routine clinical assessment. It was recorded when AF was occurred. Atrial fibrillation occurred in a ratio of 11.8 % in the all cases. There was no difference between the groups for development of AF (Group D: 11.5 %, Group I: 12 %, Group S: 11.7 %, p>0.05). In our cases age, Euroscore, postoperative need for inotropic agents, periods for cross-clemping and perfusion were found as independent risk factors in the analyzing of multivariant risks for determining the risk factors (p<0.05). As a result; we think that the uses of sevoflurane, isoflurane and desflurane have similar effects on development of AF in the patients after CABP.Öğe Factors determining the duration of tracheal intubation in patients undergoing coronary artery bypass surgery: Perioperative risk analysis(2006) Akgül Erdil F.; But A.K.; Gülhaş N.; Begeç Z.; Nisani?lu V.; Battalo?lu B.; Ersoy M.Ö.Aim of our retrospective study was to identify perioperative risk factors of extubation times after coronary artery bypass greffing (CABG). One thousand one hundred and seventy one patients undergoing CABG in our hospital between September 2001 and December 2005 were included in this study. These patients were divided into 2 groups depending on whether mechanical ventilation time was shorter than 6 hours (Group I; n=332), or longer than 6 hours (Group II; n=849). Demographic, intraoperative and postoperative patient characteristics were compared, and multivariate logistic regression analysis was used to ideatify risk factors effecting extubation time after CABG. Multivariate logistic regression analysis of demographic variables identified, age, previous MI, hypertension, COPD, unstable angina and carotid artery disease as risk factors of extubation time after CABG. Multivariate logistic regression analysis of perioperative variables identified, mean number of distal anastomoses, mean cross-clamp time, inotropic support and incidence of postoperative atrial fibrillation as risk factors for extubation time after CABG. Mean intensive care unit and hospital stays of late extubated group were found as statistically longer than that of early extubated group. In this retrospective study; it was found that preoperative variables had more important effects on late extubation than that of perioperative variables. We concluded that by improving preoperative care quality and preventing perioperative limiting factors of early extubation, more patients would benefit from early extubation. In this manner, morbidity of CABG would be decreased.Öğe Hemodynamic effects of bupivacaine and ropivacaine in cesarean section(AVES İbrahim KARA, 2006) Öztürk E.; But A.; Gülhaş N.; Begeç Z.; Do?an Z.; Yapici E.; Ersoy M.Ö.Aim: Local anesthetics for spinal aneaesthesia, provides a comfortable anaesthesia with their sensorial and motor block effect. However symphatic block causes hypotension in patients and this hypotension may cause nausea, vomiting and decrease in uterine blood flow, The purpose of this study is to compare the hemodynamic effects of equivalent doses of each ropivacainc and bupivaciane given intratecally in combination with fentanyl for elective cesarean section. Materials and Methods: Tthirty-six ASA I-II patients undergoing elective cesarean section were enrolled the study. After administration of 15 mL kg ringers lactate on sitting position combined spinal-epidural anesthesia performed. Patients randomly allocated in group B (n=18) (bupivacaine heavy 11 mg) and group R (n=18) (ropivacaine heavy 11 mg) and 25 ?g Fentanyl added to local anesthetics. Systolic arterial pressure (SAP), heart rate (HR) and sensorial block levels were recorded during the operation. Ephedrine infusion was used to obtaining a stable hemodynamia during the operation. Results: Total ephedrine infusion and total ephedrine consumption was greater in group R than in group B (p<0.01). SAP values at 2, 4, 6, 8, 10 min in Group B were significantly lower than baseline value (p<0.05). HR values at 2, 4, 6, 8, min in Group R were significantly higher compared to the baseline value (p<0.05). HR values were significantly higher than baseline value at all times except HR 20 in group B. Mean sensorial block level was (T6) in Group R and (T4) in Group B (p=0.001). Additional local anesthetic was administered the 8 patients in only group R through epidural catheter (p=0,001). No patients in group B needed to additional local anesthetics Conclusion: Lower sensorial block levels were obtained with ropivacaine when compared to the similar doses of bupivacaine. It was concluded that bupivacaine is more potent than ropivacaine in spite of opioid addition.Öğe Retrospective assessment of our anesthesia practice for electroconvulsive therapy(2008) Begeç Z.; Köro?lu A.; Gedik E.; Yücel A.; Toprak H.I.; Karlida? R.; Ersoy M.Ö.Aim: Electroconvulsive therapy (ECT) is a treatment method of some psychiatric disorders which is based on to form seizure activity by electrical stimulus. The aim of this retrospective study was to evaluate anesthetic agents which were used, the duration of seizure activity and recovery times, hemodynamic changes and the complications of the procedure in patients underwent ECT in our clinic. Materials and Methods: The anesthesia records of 460 ECT procedures performed in our clinic between October 2002-April 2007 were analyzed retrospectively. Patients were allocated to receive propofol 1 mg kg -1 after dexmedetomidine (1 ?g kg-1 h-1, 10 min.) premedication (Group 1); propofol 1,2 mg kg-1 (Group 2); propofol 1,5 mg kg-1 (Group 3); or sevoflurane 7 % (Group 4) without premedication as an induction agent. Results: Mean duration of motor seizure was 39.06±10.79 s. in Group 4, significantly longer than Group 1 and 3. Mean duration of motor seizure was 29.78±7.85 min in Group 3 significantly shorter than Group 2 (p<0.05). Duration of response to verbal stimulus in Group 3 and 4 were longer than Group 1 and 2 (p<0.05). Heart rate was lower in Group 1 compare from baseline value after convulsion at 1. and 10. min (p<0.05). Mean arterial pressure was lower at 10 min after convulsion in Group 1 and 3; at 1. and 10 min after convulsion in Group 4 (p<0.05). Conclusion: We determined that sevoflurane (7 %), 1,2-1,5 mg kg-1 dose of propofol and premedication with dexmedctomidine 1 ? kg-1 h-1 (10 min) prevent acute hemodynamic response to ECT without decreasing the duration of seizure. However, further studies of dexmedetomidine safety and interactions with other drugs are required before recommendation of its use for ECT procedures.
