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Öğe Anaesthetic Management in Electroconvulsive Therapy During Early Pregnancy(Aves, 2014) Ozgul, Ulku; Erdogan, Mehmet Ali; Sanli, Mukadder; Erdil, Feray; Begec, Zekine; Durmus, MahmutThe management of major psychiatric conditions during pregnancy is exceptionally difficult. Pharmacoresistant, life-threatening and severe symptoms such as catatonia and suicidal behavior affect the health and safety of both mother and child. In such cases, electroconvulsive therapy (ECT) may be considered as an alternative to pharmacologic treatment. In this report, we aimed to present anaesthetic management of a patient, who was 13 weeks pregnant and needed ECT due to major depression.Öğe The antimicrobial effects of ketamine combined with propofol: An in vitro study(Elsevier Science Inc, 2013) Begec, Zekine; Yucel, Aytac; Yakupogullari, Yusuf; Erdogan, Mehmet Ali; Duman, Yucel; Durmus, Mahmut; Ersoy, M. OzcanBackground and objectives: Ketamine and propofol are the general anesthetics that also have antimicrobial and microbial growth-promoting effects, respectively. Although these agents are frequently applied together during clinical use, there is no data about their total effect on microbial growth when combined. In this study, we investigated some organisms' growth in a ketamine and propofol mixture. Method: We used standard strains including Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans in this study. Time-growth analysis was performed to assess microbial growth rates in 1% propofol. Antimicrobial activity of ketamine, alone and in propofol was studied with microdilution method. Results: In propofol, studied strains grew from 103-104 cfu/mL to ?AO cfu/mL concentrations within 8-16 hours depending on the type of organism. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) (for candida, minimal fungicidal concentration) of ketamine were determined as follows (MIC, MBC): E.coli 312.5, 312.5 pg/mL; S.aureus 19.5, 156 pg/mL; P.aeruginosa 312.5, 625 pg/mL; and C.albicans 156, 156 pg/ml. In ketamine+propofol mixture, ketamine exhibited antimicrobial activity to E.coli, P.aeruginosa and C.albicans as MBCs at 1250, 625 and 625 pg/mL, respectively. Growth of S. aureus was not inhibited in this mixture (ketamine concentration=1250 pg/mL). Conclusion: Ketamine has sustained its antimicrobial activity in a dose-dependent manner against some organisms in propofol, which is a strong microbial growth-promoting solution. Combined use of ketamine and propofol in routine clinical application may reduce the risk of infection caused by accidental contamination. However, one must keep in mind that ketamine cannot reduce all pathogenic threats in propofol mixture. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe Comparison of effects of propofol and ketamine-propofol mixture (ketofol) on laryngeal mask airway insertion conditions and hemodynamics in elderly patients: a randomized, prospective, double-blind trial(Springer Japan Kk, 2013) Erdogan, Mehmet Ali; Begec, Zekine; Aydogan, Mustafa Said; Ozgul, Ulku; Yucel, Aytac; Colak, Cemil; Durmus, MahmutThe objective of this study was to compare the effects of ketamine-propofol mixture (ketofol) and propofol on ProSeal laryngeal mask airway (PLMA) insertion conditions and hemodynamics in elderly patients. Eighty elderly patients, American Society of Anesthesiologists (ASA) physical status I and II, were randomly divided into two groups to receive either propofol 0.15 ml/kg (n = 40), or ketofol (using a 1:1 single-syringe mixture of 5 mg/ml ketamine and 5 mg/ml propofol) (n = 40) before induction of anesthesia. Sixty seconds after induction, the PLMA was inserted. Heart rate and arterial blood pressure (systolic [S] BP) were recorded prior to the induction of anesthesia, immediately following induction, immediately after PLMA insertion, and 5 and 10 min after PLMA insertion. PLMA insertion conditions were scored according to mouth opening, swallowing, coughing, head and body motion, laryngospasm, and ease of PLMA insertion by the same experienced anesthesiologist, who did not know which agents were used. There were no differences in PLMA insertion conditions between the groups. The number of patients in need of ephedrine (P = 0.043) and the total dose of ephedrine (P = 0.022) were significantly lower, and apnea duration (P < 0.001) was significantly higher in the ketofol group compared with the propofol group. SBP was significantly higher in the ketofol group than in the propofol group immediately after PLMA insertion and 5 min after PLMA insertion. The same PLMA insertion conditions were found with ketofol and propofol. The number of patients in need of ephedrine and the total ephedrine dose were lower and apnea duration was increased in the ketofol group.Öğe A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial(Bmc, 2021) Karaaslan, Erol; Akbas, Sedat; Ozkan, Ahmet Selim; Colak, Cemil; Begec, ZekineBackground There are doubts among anesthesiologists on the use of the Laryngeal Mask Airway (LMA) in nasal surgeries because of concerns about the occurrence of blood leakages to the airway. We hypothesized that the use of LMA-Supreme (LMA-S) in nasal surgery is comparable with endotracheal tube (ETT) according to airway protection against blood leakage through the fiberoptic bronchoscopy, oropharyngeal leakage pressure (OLP), heart rate (HR), mean arterial pressure (MAP), and postoperative adverse events. Methods The present study was conducted in a prospective, randomized, single-blind, controlled manner on 80 patients, who underwent septoplasty procedures under general anesthesia, after dividing them randomly into two groups according to the device used (LMA-S or ETT). The presence of blood in the airway (glottis/trachea, distal trachea) was analyzed with the fiberoptic bronchoscope and a four-point scale. Both groups were evaluated for OLP; HR; MAP; postoperative sore throat, nausea, and vomiting; dysphagia; and dysphonia. Results In the fiberoptic evaluation of the airway postoperatively, less blood leakage was detected in both anatomic areas in the LMA-S group than in the ETT group (glottis/trachea, p = 0.004; distal trachea, p = 0.034). Sore throat was detected less frequently in the LMA-S group at a significant level in the 2nd, 6th, and 12th hours of postoperative period; however, other adverse events were similar in both groups. Hemodynamic parameters were not different between the two groups. Conclusion The present findings demonstrate that the LMA-S provided more effective airway protection than the ETT in preventing blood leakage in the septoplasty procedures. We believe that the LMA-S can be used safely and as an alternative to the ETT in septoplasty cases.Öğe Comparison of videolaryngoscope-guided versus standard digital insertion techniques of the ProSeal™ laryngeal mask airway: a prospective randomized study(Bmc, 2019) Ozgul, Ulku; Erdil, Feray Akgul; Erdogan, Mehmet Ali; Begec, Zekine; Colak, Cemil; Yucel, Aytac; Durmus, MahmutBackground: This study were designed to investigate the usefulness of the videolaryngoscope-guided insertion technique compared with the standard digital technique for the insertion success rate and insertion conditions of the Proseal (TM) laryngeal mask airway (PLMA). Methods: Prospective, one hundred and nineteen patients (ASA I-II, aged 18-65 yr) were randomly divided for PLMA insertion using the videolaryngoscope-guided technique or the standard digital technique. The PLMA was inserted according to the manufacturer's instructions in the standard digital technique group. The videolaryngoscope-guided technique was performed a C-MAC (R) videolaryngoscope with D-Blade, under gentle videolaryngoscope guidance, the epiglottis was lifted, and the PLMA was advanced until the tip of the distal cuff reached the oesophagus inlet. The number of insertion attempts, insertion time, oropharyngeal leak pressure, leak volume, fiberoptic bronchoscopic view, peak inspiratory pressure, ease of gastric tube placement, hemodynamic changes, visible blood on PLMA and postoperative airway morbidity were recorded. Results: The first-attempt success rate (the primary outcome) was higher in the videolaryngoscope-guided technique than in the standard digital technique (p = 0.029). The effect size values with 95% confidence interval were 0.19 (0.01-0.36) for the first and second attempts, 0.09 (- 0.08-0.27) for the first and third attempts, and not computed for the second and third attempts by the groups, respectively. Conclusion: Videolaryngoscope-guided insertion technique can be a help in case of difficult positioning of a PLMA and can improve the PLMA performance in some conditions. We suggest that the videolaryngoscope-guided technique may be a useful technique if the digital technique fails. Trial registration: ClinicalTrials.gov NCT03852589 date of registration: February 22th 2019.Öğe Dexmedetomidine attenuates lung injury induced by liver ischemia-reperfusion injury in rats(Scientific Publishers India, 2017) Sahin, Taylan; Begec, Zekine; Elbe, Hulya; Vardi, Nigar; Durmus, Mahmut; Ersoy, M. OzcanObjectives: It was aimed to evaluate histological effects of different doses of dexmedetomidine on lung injury induced by liver ischemia-reperfusion in rats. Materials and methods: Forty rats were included into the study in Inonu University Animal laboratory at 2013, In Group 1, the liver was manipulated and no occlusion of the vessels of the liver was performed. In IR Group 2, 60 min of ischemia and 60 min of reperfusion were applied. In Group 3, 10 mu g/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. In Group 4, 100 mu g/kg of dexmedetomidine was administered via intraperitoneal route 30 min before ischemia. Further procedures in groups 3 and 4 were the same as those of group 2. After the experiment was completed, the rats were killed and then histologic assessments were performed to the lung tissues. Results: Histopathological damage score in group 2 was higher than in group 1. Although lung damage was recognized as alleviated in group 3, the lesions did not completely improve. However, treatment with 100 mu g/kg of dexmedetomidine was more effective than 10 mu g/kg of dexmedetomidine injection in respect to protection of alveolar structures. The difference was found to be statistically significant between group 3 and group 4 in terms of histopathological damage score. Conclusions: The present study suggests that dexmedetomidine administration may be beneficial for preventing lung injury induced by hepatic IR.Öğe Does leflunomide attenuate the sepsis-induced acute lung injury?(Springer, 2008) Ozturk, Erdogan; Demirbilek, Semra; Begec, Zekine; Surucu, Murat; Fadillioglu, Ersin; Kirimhoglu, Hale; Ersoy, M. OzcanThe organ that is affected first and most severely in intraabdominal sepsis is the lung. Oxygen radicals and active neutrophils in the lung are important sources for severe pulmonary inflammation leading to acute lung injury (ALI)/acute respiratory distress syndrome. The aim of this study was to investigate the effects of leflunomide, an immunomodulatory agent, on oxidant/antioxidant status with nitric oxide (NO) level and myeloperoxidase (MPO) activity in rats with sepsis-induced ALI. Fifty male Wistar albino rats were divided into five groups: control, sham, sepsis, leflunomide (10 mg/kg, intragastrically for two doses with an 8 h interval prior to the experiment) and sepsis + leflunomide. After the animals were anesthetized with ketamine and xylazine, the abdominal cavity was opened and ligated just below the ileocaecal valve with 3-0 silk. The antimesentric surface of the cecum was perforated and the cecum was gently compressed until fecal matter was extruded to induce sepsis. None of the rats received antibiotics during the experimental procedures. The experiment was ended 24 h after cecal ligation puncture (CLP) with the cervical dislocation under anesthesia. The lung tissues were removed for analysis of biochemical parameters and light microscopic investigation. The lung superoxide dismutase (SOD), catalase and glutathione peroxidase activities were decreased in the sepsis group as compared to the group control, sham, leflunomide and sepsis + leflunomide (P < 0.05), and SOD activity were significantly higher in group sepsis + leflunomide than sham, control, leflunomide and sepsis group (P < 0.05). The lung MPO, malondialdehyde (MDA), protein carbonyl and NO levels were higher in the sepsis group when compared to group control, sham, leflunomide and sepsis + leflunomide (P < 0.05), and MPO, MDA and NO levels were higher in the sepsis + leflunomide group than in the sham, control and leflunomide group (P < 0.05). The light microscopic evaluation showed that pulmonary architecture was preserved, and infiltration of neutrophil and edema decreased in sepsis + leflunomide group. The grade of alveolar damage was significantly decreased in sepsis + leflunomide group in comparison with sepsis group (P < 0.05). Our findings suggested that leflunomide attenuated the lung injury after CLP-induced sepsis by inhibition of neutrophils accumulation and increasing endogenous antioxidant capacity.Öğe The effect of magnesium on emergence agitation in children undergoing adenotonsillectomy under sevoflurane general anesthesia: a prospective randomised clinical trial(Drunpp-Sarajevo, 2012) Yucel, Aytac; Begec, Zekine; Ozgul, Ulku; Aydogan, M. Said; Gulhas, Nurcin; Ersoy, M. OzcanBackground: The aim of this study was to assess the effect of magnesium on the incidence of emergence agitation in preschool-aged children undergoing adenotonsillectomy with sevoflurane anaesthesia. Patients & Methods: 42 children, aged between 3 to 7 years, were randomised into either group M (magnesium, n=26) or group C (saline for controls, n=26). Anesthesia was induced by mask with 8 % sevoflurane in nitrous oxide and oxygen. Magnesium 15 mg.kg(-1) or saline was administered in about 20 minutes after the endotracheal intubation intraoperatively. All patients were ventilated with 60% nitrous oxide and sevoflurane was given at 1-1.5 MAC in oxygen. Mean blood pressure, heart rate, pulse oximetry, eye-opening time, extubation time were recorded in the operating room. In recovery, patients were evaluated using modified Aldrete score, the Pediatric Anesthesia Emergence Delirium (PAED) scale and the Oucher visual analog Pain Scale. Postoperative nause, vomiting, and airway complication and first analgesic application were recorded. Results: Time to eye opening, tracheal extubation, and first analgesic administration were not different between the groups. There were no statistically significant differences in mean arterial pressure and heart rate, pain score and PAED peak scale between the groups (p > 0.05). The modified Aldrete score was significantly lower in the magnesium group (p=0.004). There was no statistically significant difference between the groups regarding side effects. Conclusions: We conclude that the administration of magnesium 15 mg.kg(-1) did not have any significant effect in reducing the incidence of emergence agitation in children undergoing adenotonsillectomy under sevoflurane anaesthesia.Öğe The effect of placement of a support under the shoulders on laryngeal visualization with a C-MAC Miller Video Laryngoscope in children younger than 2 years of age(Wiley, 2019) Gencay, Zeynep Koylu; Begec, Zekine; Ozgul, Ulku; Colak, CemilBackground We aimed to evaluate glottis visualization and time to intubation in children younger than 2 years of age during laryngoscopy performed with a C-MAC Miller Video Laryngoscope in a position determined by placing a folded towel under the shoulders to align the oral-pharyngeal and laryngeal axes in the horizontal plane. Methods Ninety-six children younger than 2 years of age, who were classified by the American Society of Anesthesiologists as having a physical status I or II and who were scheduled for elective surgery necessitating endotracheal intubation under general anesthesia, were included in the study. All patients were intubated with a C-MAC Miller Video Laryngoscope. The children intubated by placing a folded towel under the shoulders were categorized as Group 1 (n = 48), and the children intubated without placement of a folded towel were categorized as Group 2 (n = 48). The percentage of glottis opening and Cormack-Lehane Scores, values of visual analogue scale to determine the ease of using a C-MAC Miller Video Laryngoscope, time to intubation, number of intubation attempts, optimization procedures and complications were recorded for all children. Results There was a statistically significant difference between Group 1 (mean +/- SD; 97.71 +/- 4.24) and Group 2 (mean +/- SD; 94.17 +/- 7.09) in terms of the percentage of glottis opening scores (P = 0.004). The mean difference in the percentage of glottis opening scores (95% confidence interval) between the groups was 3.54 (1.17-5.90). Conclusion We showed that a folded towel placed under the shoulders in children younger than 2 years of age improves glottis visualization provides ease of use of the C-MAC Miller Video Laryngoscope. Therefore, we think that the placement of a folded towel under the shoulders during the use of a C-MAC Miller Video Laryngoscope may be useful for airway management in children younger than 2 years of age.Öğe The effects of dexmedetomidine on liver ischemia-reperfusion injury in rats(Academic Press Inc Elsevier Science, 2013) Sahin, Taylan; Begec, Zekine; Toprak, Huseyin I.; Polat, Alaadin; Vardi, Nigar; Yucel, Aytac; Durmus, MahmutBackground: Ischemia-reperfusion (IR) injury of the liver may cause various types of damage to hepatic tissues. It can affect the prognosis of patients and the success of an operation. Dexmedetomidine is a selective alpha(2) receptor agonist. We investigated whether dexmedetomidine provides protection against IR-induced liver injury in rats. Methods: Forty rats were divided equally into four groups. In group 1, the liver was manipulated after the laparotomy, and no occlusion of the vessels of the liver was performed. In group 2, once the abdomen was opened, 60 min of ischemia and 60 min of reperfusion were applied according to the segmental hepatic ischemia model. In group 3, 10 mu g/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. In group 4, 100 mu g/kg of dexmedetomidine was injected into the peritoneal cavity 30 min before ischemia. Further procedures in groups 3 and 4 were the same as those of group 2. After the experiment was completed, the rats were killed. Liver tissues were removed and stored until biochemical and histologic assessments were performed. Results: The malondialdehyde level in group 2 was higher than that of groups 1, 3, and 4 (P = 0.001, P = 0.000, and P = 0.000, respectively). Superoxide dismutase, catalase, and glutathione levels in group 2 were lower than those in group 1 (P = 0.001, P = 0.027, and P = 0.014, respectively). Superoxide dismutase and catalase levels in group 4 were higher than those in group 2 (P = 0.002 and P = 0.000, respectively). GSH levels in groups 3 and 4 were higher than those in group 2 (P = 0.049 and P = 0.006, respectively). A lower glutathione peroxidase level was detected in groups 2 and 3 than that in group 1 (P = 000). Group 4 demonstrated an increase in glutathione peroxidase levels compared with group 3 (P = 0.014). The histologic injury scores in groups 2-4 were higher than those in group 1 (P = 0.003, P = 0.002, and P = 0.001, respectively). However, the histologic injury scores were lower in groups 3 and 4 than those in group 2 (P = 0.003 and P = 0.002, respectively). Conclusions: This study showed that dexmedetomidine may protect the liver against IR injury in rats. (C) 2013 Elsevier Inc. All rights reserved.Öğe The Effects of Dexmedetomidine on Liver Ischemia-Reperfusion Injury in Rats(Wiley-Blackwell, 2012) Sahin, Taylan; Begec, Zekine; Toprak, Huseyin I.; Polat, Alaadin; Vardi, Nigar; Yucel, Aytac; Durmus, Mahmut[Abstract Not Available]Öğe Effects of Propofol or Etomidate on QT Interval During Electroconvulsive Therapy(Lippincott Williams & Wilkins, 2009) Erdil, Feray; Demirbilek, Semra; Begec, Zekine; Ozturk, Erdogan; Ersoy, Mehmet OzcanBackground: Because patients with major depression have an altered autonomic nervous system activity, the risk of arrhythmias and sudden cardiac death may be increased. In addition, electroconvulsive therapy (ECT) may cause an acute rise in QT dispersion, which may predispose to arrhythmias. In this study, we investigated the effects of propofol or etomidate on the corrected QT (QTc) interval during ECT in patients with major depression. Materials and Methods: Fourteen unpremedicated American Society of Anesthesiologists 1 patients, each scheduled for 6 ECT sessions for major depression, were included in a prospective, randomized crossover study The patients randomly received either 1-mg/kg propofol (propofol group) or 0.2-mg/kg etomidate (etomidate group). The mean arterial pressure (MAY), heart rate (HR), and electrocardiogram were recorded before anesthetic induction, 0 and 1 minute after the seizure ended, and 3 and 10 minutes after the seizure ended (T3 and T4, respectively). Results: In the propofol group, the QTc interval was shorter than the baseline at 0 minute after the seizure ended. The QTc interval increased from the baseline at T3 and T4 in the etomidate group. In the etomidate group, the QTc interval was longer at T3 and T4 than that in the propofol group (P < 0.05). In the etomidate group, the HR increased at T3 and T4, but the MAP increased at all measurement times from the baseline value. The HR and the MAP were lower at T3 and T4 in the propofol group than in the etomidate group (P < 0.05). Conclusions: Propofol did not induce prolongation of the QT interval and controlled the hemodynamic response better than etomidate during ECT. Therefore, propofol may be more suitable than etomidate for ECT treatments.Öğe Effects of sevoflurane or ketamine on the QTc interval during electroconvulsive therapy(Springer Japan Kk, 2015) Erdil, Feray; Begec, Zekine; Kayhan, Gulay Erdogan; Yologlu, Saim; Ersoy, Mehmet Ozcan; Durmus, MahmutTo evaluate the effect of sevoflurane or ketamine on the corrected QT (QTc) interval and the interval from the peak to the end of the T wave (Tp-e) during electroconvulsive therapy (ECT) in patients with major depression. This prospective, randomized, double-blinded study included 24 patients that were randomly allocated to receive sevoflurane (group S) or ketamine (group K) for ECT session. Group S patients received 8 % sevoflurane for anesthesia induction, which was maintained at 2-4 % until delivery of the electrical stimulus. Group K patients received a bolus of ketamine (1 mg/kg). The mean arterial pressure (MAP) and heart rate (HR) and the electrocardiogram (ECG) were recorded before (T1) and after induction of anesthesia (T2) and 0, 1, 3, and 10 min after the electrical stimuli ended (T3, T4, T5, and T6, respectively). In both groups, the QTc interval was significantly longer at T2, T4, T5, and T6 than at baseline. The QTc interval was longer at T4, T5, and T6 in group S compared to that in group K, the Tp-e interval was significantly longer at T4 in group K both baseline and group S. The HR in group S was increased at T4 compared with group K. MAP was significantly higher after induction of anesthesia in group K compared to those in group S at all time points. Although group S showed a prolonged QTc interval after ECT compared to group K, the Tp-e interval in both groups was not significantly affected clinically. Sevoflurane blunted MAP and peak HR.Öğe The Hemodynamic Effects of Dexmedetomidine and Esmolol in Electroconvulsive Therapy A Retrospective Comparison(Lippincott Williams & Wilkins, 2013) Aydogan, Mustafa Said; Yucel, Aytac; Begec, Zekine; Colak, Yusuf Ziya; Durmus, MahmutAim: Acute hemodynamic responses, including transient hypertension and tachycardia, to electroconvulsive therapy (ECT) predispose vulnerable patients to significant cardiovascular complications. Many drugs have been used in an attempt to attenuate these responses. To date, no comparative study of the acute hemodynamic effects of dexmedetomidine and esmolol in ECT has been published. Hence, this retrospective study aimed to compare the effects of dexmedetomidine and esmolol on acute hemodynamic responses in patients undergoing ECT. Materials and Methods: The anesthesia records for 66 patients who underwent a total of 198 ECT treatments performed between July 2009 and January 2010 were analyzed retrospectively. For each case, 1 seizure with 1-mg/kg propofol as control (group C), 1 seizure with 1-mu g/kg dexmedetomidine combined with propofol (group D; total volume, 30 mL for 10 minutes), and 1 seizure with 1-mg/kg esmolol combined with propofol were compared (group E; total volume, 30 mL for 10 minutes). Anesthesia was induced with 1-mg/kg propofol, and then intravenous succinylcholine, 0.5-mg/kg, was administered. Heart rates and systolic and mean blood pressures were recorded at baseline (T-0) and 1, 3, and 10 minutes after the seizure (T-1, T-2, and T-3, respectively). The electroencephalographic (EEG) tracing motor seizure duration, and recovery times (spontaneous breathing, eye opening, and obeying commands) were recorded. Results: The baseline hemodynamic measurements were similar between the groups. Heart rates at T-1, T-2, and T-3 were lower in group D than those in groups E and C (P < 0.05). Systolic blood pressures at T-1, T-2, and T-3 were lower in group D than those in groups C (P < 0.05). In addition, systolic blood pressure at T-3 was lower in group D than that in group E (P < 0.05). The mean blood pressure at T3 was significantly lower in group D than those in groups E and C (P <0.05). The electroencephalographic tracing, motor seizure durations, and recovery times were similar between the groups. Conclusion: Dexmedetomidine administration before anesthesia induction reduced the acute hemodynamic response compared with esmolol administration in the early period of ECT. Therefore, dexmedetomidine may be effective in preventing acute hemodynamic responses to ECT.Öğe Postoperative Cognitive Dysfunction in Living Liver Transplant Donors(Baskent Univ, 2014) Bucak, Nizamettin; Begec, Zekine; Erdil, Feray; Toprak, Huseyin Ilksen; Cumurcu, Birgul Elbozan; Demirtas, Yasemin; Yologlu, SaimObjectives: Postoperative cognitive dysfunction is a serious complication that may be associated with increased mortality. Living-donor liver transplant includes major surgery for the donor. The purpose of this study was to evaluate preoperative and postoperative cognitive function of liver donors in living-donor liver transplant. Materials and Methods: In 102 patients who had hepatectomy for liver transplant donation, preoperative and postoperative (1 week) neuropsychologic tests were performed including the Trail Making Test, the Stroop effect, score on the Beck Depression Inventory, and the mini-mental state examination. Results: Liver transplant donors had significantly lower mean Trail Making A Test duration and greater mean Trail Making B Test error number after than before surgery. The mean Stroop effect reading durations (black and white reading; reading colored words) were significantly greater after than before surgery; the mean time difference between naming the colors of colored words minus reading colored words, and the error number, were smaller after than before surgery. The mean score on the Beck Depression Inventory and mini-mental state examination score were similar before and after surgery. Conclusions: Mild frontal lobe dysfunction may be present in liver donors at 1 week after surgery, and postoperative attention problems may be experienced by these patients.Öğe Remifentanil and propofol for tracheal intubation without muscle relaxant in children: the effects of ketamine(Lippincott Williams & Wilkins, 2009) Begec, Zekine; Demirbilek, Semra; Ozturk, Erdogan; Erdil, Feray; Ersoy, M. OzcanBackground and objective Remifentanil and propofol have been proposed for intubation without muscle relaxant to avoid the adverse effects of muscle relaxants in children. We hypothesized that the addition of ketamine to remifentanil and propofol would improve intubating conditions and provide haemodynamic stability. Methods We studied 88 children (3-12 years) undergoing elective surgery. Group K received ketamine 0.5 mg kg(-1), remifentanil 3 mu g kg(-1) and propofol 3 mg kg(-1). Group C received isotonic saline instead of ketamine, all other study drugs were same as in group K. Sixty seconds after administration of propofol, laryngoscopy and tracheal intubation were performed. Intubating conditions were graded. Mean arterial pressure (MAP), heart rate (HR) and SPO2 were recorded. Results The intubating conditions were regarded as clinically acceptable in 39 out of 44 (89%) children in group K and in 36 out of 44 (82%) children in group C. Although there was no failed intubation in group K, the intubation failed in six children in group C (P<0.05). Tracheal intubation failed in 4/6 children because of severe coughing and/or limb movement, and in 2/6 children because of closed vocal cords. Scores for limb movement were significantly lower in group K than in group C. When compared with baseline, HR and MAP significantly decreased in both groups during the study (P<0.05). Conclusion The addition of ketamine to remifentanil and propofol prevented failed intubation and slightly increased the percentage of acceptable intubating conditions. Ketamine had no influence on haemodynamic changes following remifentanil and propofol administration in given doses. Eur J Anaesthesiol 26:213-217 (C) 2009 European Society of Anaesthesiology.Öğe Response to: The effect of placement of a support under the shoulders on laryngeal visualization with a C-MAC Miller Video Laryngoscope in children younger than 2 years of age(Wiley, 2020) Koylu Gencay, Zeynep; Begec, Zekine; Ozgul, Ulku; Colak, Cemil[Abstract Not Available]
