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Öğe Antioxidant effects of midazolam, isoflurane and desflurane during coronary artery by-pass grafting surgery(2009) Öztürk E.; But A.; Toprak H.I.; Demirbilek S.; Güleç M.; Ersoy M.Ö.It has been suggested that the reactive oxygen species (ROS) have essential role in the pathogenesis of myocardial ischemia-reperfusion injury. ROS may cause cardiac problems such as myocardial stunning, tissue damage and reperfusion cardiac arrhythmias may occur during weaning from pump in coronary artery bypass grafting (CABG). The aim of this study was compare the effects of midazolam, isoflurane, and desflurarie on the oxidative stress and hemodynamic parameters during CABG. After standard anesthesia induction, ninety patients were randomly allocated to Group M (midazolam), Group 1 (isoflurane), Group D (desflurane). Blood samples were obtained from the retrograde cannula placed in the coronary sinus; just prior to connecting to the pump (T1) and 5 minute after the cross-clamp removal (T2). In group M, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and adenosine deaminase (ADA) significantly increased, and nitric oxide (NO) and malondialdehyde (MDA) decreased at the T2 compared to the T1 (p<0.05). In Group 1, SOD and ADA increased at the T2 compared to the T1. While NO and MDA decreased, ADA increased in Group D at the T2 in comparison with the T1 (p<0.05). GSH-Px was significantly higher in Group M than Group 1 and D at the T2 (p<0.05). Although ADA was lower at the T2 in Group M than Group 1 and D, but there was only statistically significant difference between Group M and D (p<0.05). Midazolam had greater stimulating capacity on the endogenous antioxidant system and may caused less cellular damage than isoflurane and desjlurane due to its effects on the ADA.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 Relationship between nitric oxide levels and delirium in patients with coronary bypass operation(2004) Sezer Ö.; Karlida? R.; Karabulut A.B.; Özcan C.; Nisano?lu V.; Türköz Y.; But A.Objective: Delirium is an acute brain failure which is related to various pathological conditions. Although there are some ideas about etiopathogenesis of delirium, some points have not been cleared yet. We aimed to investigate relationship between nitric oxide (NO) levels and delirium prospectively in patients with in coronary bypass operation. Methods: We included 50 (37 males, 13 females, ages: 37-75, mean±sd= 59.8±10.6) patients with coronary illnesses who will undergo bypass operation. Patients with dementia and any systemic disease, except hypertension and coronary artery disease, were excluded from study. Smoking was not allowed at least 7 days prior to operation. We diagnosed delirium using DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) criteria. Delirium Rating Scale was used to estimate delirium severity. Blood samples were taken pre-operationally and post operationally. Patients were divided into two groups as delirium group and nondelirium group. We compared the two groups according to NO levels. Results: 12 of the 50 patients had delirium. While there was no significant difference among blood NO levels pre-operationally between two groups, the NO levels were statistically higher in the delirium group than the nondelirium group. Conclusion: Our study is important since it is first study that investigated the relationship between NO and delirium. Blood NO levels become higher in patients who developed post operationally delirium. These findings can be explained by increased NO production in brain tissue due to increased cerebral ischemia and/or increased response to oxidative stress during operation.Öğe Serum electrolytes and nitric oxide levels in acute hypotension following intravenous heparin(2006) Toprak H.I.; Begec Z.; But A.; Sizanli E.; Bayraktar N.; Ersoy M.O.Heparin is frequently used as an anticoagulant agent for patients undergoing surgery with cardiopulmonary bypass. In literature, severe hypotension as a side effect of high dose bolus heparin has been already reported. However, the exact mechanism of hypotension has not yet fully been understood. The aim of the study was to investigate the relationship between hemodynamic instability induced by heparin and levels of serum electrolytes and nitric oxide. Forty patients undergoing elective coronary artery bypass grafting were included into the study. Patients with sudden decrease in mean arterial pressure (MAP) higher than 25 % of the baseline after heparin administration were included into group H (n=20). Besides, consecutive twenty hemodinamically stabile patients (with none or a MAP decrease lower than 25 % of baseline) constituted group N (n=20). Anesthetic techniques were standardized. Arterial blood gases were analyzed for pH, PaO2, PaCO2, potassium, sodium, calcium, magnesium, hematocrit before and 5 minutes after heparin administration. Synchronous serum nitric oxide levels analysis were also performed. The nitric oxide levels were measured as reflected by the formation of its stable end-metabolites, nitrite and nitrate. Serum electrolyte and nitric oxide levels were not statistically different neither between before and after heparin administration nor between hypotension group and normotension group. Hypotension observed after heparin administration was not related with the concentration of serum electrolytes and nitric oxide.
