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Öğe Acute Normovolemic Hemodilution in Coronary Artery Bypass Surgery: Effects on Inflammatory Response(2003) Durmuş M.; Karaaslan K.; But A.K.; Do?an Z.; Sezgin N.; Ersoy M.Ö.Acute normovolemic hemodilution is the removal of the blood from patients before or shortly after induction of anesthesia, and simultaneous replacement with acellular fluid, that is crystalloid or colloid and retransfusion of removed blood if needed. In this study we aimed to evaluate the effects of acute normovolemic hemodilution on and enflammatory response in patients undergoing coronary artery bypass surgery. After Ethics Committee approval 40 patients undergoing coronary artery bypass surgery were divided into two groups randomly. After induction of anesthesia, one or two units of blood were drawn from the Group I (n=20) until the hematocrit values became lesser than < 35%. At the same time, volume replacement was achieved with same amount of colloid infusion from peripheral vein. Any additional procedure was not done to the control group (Group II, n=20). Alanine transaminase, aspartate transaminase, lactate dehydrogenase, creatine kinase MB, creatine phosphokinase, ?-glutamyl transferase, complement 3a, complement 4a, ferritin, transferrin, nitric oxide, C-reactive protein and haptoglobulin levels were measured before induction, after operation, postoperative 6th and 24th hours. The amount of transfused allogenic blood was lower in Group I compared to group II (p<0.05). It was detected that complement system was not induced in two groups; lactate dehydrogenase, creatine kinase MB and nitric oxide levels were higher in Group II at postoperative 6 th, ferritin level was higher in group I at postoperative 24 th hours statistically (p<0.05). It was concluded that the effect of acute normovolemic hemodilution regarding to complement system was not different from control group and lower levels in lactate dehydrogenase, creatine kinase MB and nitric oxide can show that organ functions can be better prevented with acute normovolemic hemodilution.Öğe Anaesthetic management of a phaeochromocytoma patient with aortic valve insufficiency(2002) But A.K.; Durmuş M.; Gedik E.; Karaaslan K.; Toprak H.I.; Ersoy M.O.Phaeochromocytoma is an uncommon neuroectodermic tumour of adrenal medulla. Additional cardiac problems make anaesthesia management of phaeochromocytoma more complicated. We aimed to present the anaesthetic management of phaeochromocytoma patient with aortic valve insufficiency (AVI). A 45 years-old, 65 kg, female patient with third degree of AVI was admitted for phaeochromocytoma surgery. Before surgery, she was pre-treated with phenoxybenzamine and nicardipine for a week. In the operation room, thoracic epidural analgesia was maintained with 10 mL 0.5% bupivacaine loading dose, followed by 5 mL 0.5% bapivacaine for every hour during surgery. Then anaesthesia was induced with midazolam, droperidol, fentanyl, vecuronium, metoprolol and lidocaine. High dose fentanyl anaesthesia with 0.5-1.5% isoflurane were preferred for maintenance of anaesthesia. Haemodynamic stability was obtained with this anaesthesia management with lower dose vasodilators until the resection of adrenal mass. After the resection, severe hypotension was controlled with inotropic agents. Surgery was completed uneventfully and patient was transferred to ICU. In phaeochromocytoma cases with AVI, we think that appropriate anaesthetic approach is the thoracal epidural analgesia and high dose fentanyl anaesthesia with support of vasodilatators or vasoactive agents.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 Application of prilocaine-lidocaine cream for the internal jugular venous cannulation and comparison with prilocaine HCI infiltration(2005) Köro?lu A.; Çiçek M.; But A.K.; Toprak H.I.; Ersoy M.Ö.In this study, it was aimed to evaluate the effects of prilocaine-lidocaine cream applied at different durations on the quality analgesia and procedure and to compare them with those of prilocaine HCI infiltration for internal jugular venous (IJV) cannulation. Seventy-five cases performing IJV cannulation before operations were included in the study. Prilocaine-lidocaine cream was applied before IJV cannulation in Groups I, II, III, and IV during 60, 90, 120 and 180 min, respectively. Prilocaine HCI infiltration was applied in cases of Group V. The level of pain was evaluated with the visual analogue scale during infiltration of prilocaine HCI and IJV cannulation. In addition, the depth of skin-İJV, the quality of analgesia and procedure were recorded. Adequate skin analgesia was obtained in all cases. Number of cases obtained adequate analgesia at different depths in cases in which prilocaine-lidocaine cream was applied were higher in Groups III and IV than in Groups I and II at 0.5 cm depth, higher in Group IV than in Groups I and II, and in Group III than in Group I at 1 cm depth, and higher in Group IV than in Group I at 1.5 cm depth. The quality of analgesia was better in group IV than in Groups I and II. Total number of cases obtained adequate analgesia was significantly higher, the requirement of additional 2% prilokain HCI infiltration was lower in Group IV than in Groups I and II, and also in Group V than in Groups I, II, and III, during IJV cannulation. As a result, we hold the opinion that prilocaine-lidocaine cream applied for 3 h provided more effective analgesia than the shorter duration of application. Also, since when it was applied during 90, 120, and 180 min it provided clinically better the quality of procedure it could be a better alternative to the prilocaine HCI infiltration.Öğe Comparison of cardiovascular effects and intubating conditions of cisatracurium and rocuronium in patients with coronary artery disease(2000) Torkoz A.; But A.K.; Koroglu A.; Durmus M.; Togal T.; Ersoy M.O.This study was designed to compare the cardiovascular effects and intubation condition of cisatracurium and rocuronium in cardiac surgical patients. Twenty patients scheduled for elective coronary artery bypass surgery were randomly assigned into two equal groups in a double blind fashion. Patients in group R (n=10) were given 0.9 mg/kg rocuronium and patients in group C (n=10) were given 0.15 mg/kg cisatracurium. Tracheal intubation was performed upon completion of maximum depression (% 100) in Train-of-four stimulation. Intubation conditions were rated according to Goldberg scale [1 (excellent) to 4 (intubation not possible)]. Heart rate (HR), systolic and diastolic arterial pressure SAP and DAP), central venous pressure (CVP), mean pulmonary artery pressure (PAPm), pulmonary artery wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), systemic and pulmonary vascular resistances (SVR and PVR) were measured invasively. Measurements were made before induction, 2 min after induction of anesthesia (basal), 1 min after after administration of muscle relaxant, at maximum depression in TOF and 2, 5, 10 min after intubation. Intubation condition were excellent in 60% of patients in the rocuronium group and in 90% of patients in the cisatracurium group, however there were no significant differences between the two groups (p>0.05). Rocuronium produced statistically significant increase in the heart rate at maximum depression in TOF, 2 min after intubation and in systolic blood pressure at 2 min after intubation (p<0.05). Other hemodynamic changes (DBP, CVP, CO, CI, PAPm, PAWP, SVR, PVR) were similar in the groups. As a result, induction with cisatracurium presented a more haemodynamically stable situation than rocuronium, but increases of cardiac rate and blood pressure with rocuronium were within clinically acceptable values.Öğe Dextrane 40 followed by cardiac arrest(2000) Turkoz A.; Gulcan O.; But A.K.; Hazar A.; Ersoy O.Anaphylactic reaction due to dextrane 40 is uncommon. A case of anaphylactic reaction followed by cardiac arrest after intravenous dextran 40 infusion in postoperative period is reported. In this case, Cardiopulmonary resuscitation was continued for 116 min after the cardiac arrest and the case was recovered completely. The possible etiology, manifestations, and management of the adverse drug reaction are discussed.Öğe Does single dose premedication of dexmedetomidine reduce pain during injection of propofol?(2007) Erdil F.A.; Gulhas N.; But A.K.; Begec Z.; Ersoy M.O.Background and objective: Pain on injection is still a major problem with propofol. In this study, we compared the efficacy of single-dose premedication of dexmedetomidine for pain on injection of propofol and its effect on the incidence and the severity of the pain after propofol injection. Methods: We conducted a prospective, randomized and double-blind study of 100 patients scheduled to undergo surgery. Patients were randomly assigned to one of two groups, either receiving dexmedetomidine (Group D) or saline (Group C) before the injection of propofol. Patients in Group D (n = 50) were given dexmedetomidine infusion 0.6 ?g/kg for 10 min. Patients in Group C (n = 50) were given saline infusion in an identical manner. Pain perception was assessed during injection of propofol in all patients. Results: The median pain score on injection of propofol was significantly lower in Group D than in Group C (median pain score 2 [1-3] vs 1 [0-2]; P < 0.006). The number of patients with pain in Group D decreased (48/50 [96%] in Group C vs 42/50 [84%] in Group D; P = 0.046). Conclusions: Intravenous administration of a single dose of dexmedetomidine as a premedication reduced the incidence and severity of pain on propofol injection without significant adverse haemodynamic effects. © 2007 W.S. Maney & Son Ltd.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 The effects of acute normovolemic hemodilution on coagulation parameters in coronary artery bypass surgery(2003) Durmuş M.; Karaaslan K.; But A.K.; Erdem T.B.; Sezgin N.; Ersoy M.Ö.Acute normovolemic hemodilution reduces allogenic blood transfusion requirements during surgery. We aimed to investigate the effects of acute normovolemic hemodilution on hemostasis after cardiopulmonary bypass by comparing routine coagulation tests, thrombin-antithrombin III complex, fibrinogen, D-dimer, protein C and S levels. After Ethics Committee approval 40 patients undergoing coronary artery bypass surgery were divided into two groups randomly. After induction of anesthesia, one or two units of blood were drawn from the Group I (n=20) until the hematocrit values became less than < 35% (Htc < 35%). At the same time, volume replacement was achieved with same amount of colloid infusion from peripheral veins. No additional procedure was done to Group II (n=20). All coagulation tests were measured before induction, at the end of surgery, at postoperative 6th and 24th. In addition to this time periods, thrombin-antithrombin III complex, fibrinogen and D-dimer levels were measured before cardiopulmonary bypass. The amount of transfused allogenic blood was lower in Group I compared to Group II (p<0.05). Routine coagulation tests remained within normal limits. Before cardiopulmonary bypass, fibrinogen, thrombin-antithrombin III complex and D-dimer levels were higher in Group I compared to Group II statistically (p<0.05). Protein C level was less at the end of surgery in Group I (p<0.05). Fragmentation ratio was detected lower in Group I than Group II (P<0.01). We concluded that, although acute normovolemic hemodilution reduces allogenic blood transfusion requirement and fragmentation ratio, it may activate coagulation and fibrinolysis in patients undergoing coronary artery bypass surgery.Öğe The effects of acute normovolemic hemodilution on postoperative cognitive functions in coronary artery bypass surgery(2003) Durmuş M.; Karaaslan K.; But A.K.; Toprak H.I.; Tekşan H.; Ersoy M.Ö.Moderate acute normovolemic hemodilution is tolerated well in most of cardiovascular surgery even in coronary artery bypass grafting (CABG). In this study we aimed to evaluate the effects of acute normovolemic hemodilution on postoperative cognitive functions in patients undergoing CABG surgery. After Ethics Committee approval, 62 patients undergoing coronary artery bypass surgery were studied. Patients were divided into hemodilution (Group H, n=31) and control (Group K, n=31) groups randomly. After induction of anesthesia, one or two units of blood were drawn from the Group H until the hematocrit values were lower than 35 %. At the same time, volume replacement was achieved with same amount of 6 % hydroxyethyl starch (HAES-steril 6 % (HES 200/0.5), Fresenius Kabi) infusion from peripheral vein. Any additional procedure was not performed in the Group K. Cognitive functions were evaluated with using "Wechsler Revised Memory Scale" one day before surgery, third day and at the end of first month after surgery. Both Forward and Reverse Digit Series and Figural Memory scores of Group H were higher than the control group at the postoperative third day and first month (p<0.05). Total scores of two groups were higher than the preoperative scores at the end of first month (p<0.05). It was concluded that acute normovolemic hemodilution during CABG surgery conserves postoperative attention and figural memory functions. Increased total scores in two groups at first month reflect the learning effects.Öğe Effects of dexmedetomidine and midazolam sedation on the haemodynamic response to epinephrine(Anestezi Dergisi, 2007) Erdil F.; But A.K.; Toprak H.I.; Öztürk E.; Ersoy M.Ö.Objective: The aim of our study is to evaluate the haemodynamic response of midazolam and dexmedetomidine sedation to local anaesthetic (LA) infiltration containing epinephrine and the analgesic effects and sedation during septoplasty operations. Methods: Dexmedetomidine (Group D; n:25) and midazolam (Group M; n:20) were given to patients as their sedation levels reached 3-4. The mean blood pressure (MBP), heart rate (HR), and visual analog scale (VAS) values were recorded preoperatively, after induction doses of sedation agents, after the infiltration of local anesthesia containing epinephrine and perioperatively. Postoperatively MBP and HR were recorded at 1, 2, 4, 6, 12, and 24 hours and the pain score of the patients was evaluated by VAS. Results: In group D, MBP after 10. minutes perioperatively, and HR after the dexmedetomidine induction, perioperatively at 20 and 30 minutes and postoperatively in the first hour were significantly lower when compared with the initial values (p<0.05). In group M, MBP after the induction and postoperatively at the 2nd hour was significantly lower when compared with the initial values, but HR was significantly increased after the induction, until the perioperative 30th minute (p<0.05). As for the evaluation of the groups: in group D, MBP till the perioperative 30th minute and postoperatively at 1, 4 and 24 hours, and HR between the end of induction and the perioperative 30th minute were significantly lower when compared with group M (p<0.05). Total diclophenac consumption was significantly lower and the time to the first analgesic requirement was also significantly longer in group D when compared with group M (p<0.05). Postoperative VAS values were significantly lower in group D when compared with group M. Conclusion: The results of our study showed that dexmedetomidine sedation could be preferred in septoplasty operations because of its beneficial effects on haemodynamic response after LA infiltration containing epinephrine and for its analgesic properties which is important in the postoperative period.Öğe The effects of dexmedetomidine on sevoflurane minimum alveolar concentrations(2005) Durmuş M.; But A.K.; Erdem T.B.; Do?an Z.; Ersoy M.Ö.Aim: Dexmedetomidine is an ?2-adrenoreceptor agonist and that reduces the anaesthetic requirement during total intravenous anaesthesia and inhalational anaesthesia. The purpose of this study was to evaluate whether dexmedetomidine administered before anesthesia induction reduces sevoflurane minimum alveolar anaesthetic concentration for endotracheal intubation (MAC EI) and skin incision (MAC). Materials and Methods: Patients were divided into MA-CEI-study and MAC-study subgroup. Both subgroups included 30 patients who were scheduled for elective surgery. Patients were not premedicated before induction of anesthesia and randomly assigned to receive iv saline 0.9% (Group I, n=15 in the each study subgroup) or dexmedetomidine 10 ?g kg-1 bolus + 1 ?g kg-1 h-1 continuous infusion (Group II, n=15 in the each study subgroup). Results: Median and 95% confidence limits for sevoflurane MACEI were 3.06 (2.89-3.25) and 2.69 (2.52-2.84), and for sevoflurane MAC were 2.21 (2.09-2.34) and 1.96 (1.84-2.09) in groups I and II, respectively. There were no significant differences regarding the MACEI and MAC of sevoflurane between groups. Conclusion: We conclude that: dexmedetomidine has no-significant affect on sevoflurane MAC, during endotracheal intubation and skin incision in this group of patients.Öğe The effects of fetal sex on local anaesthetic requirement in cesarean sections(2005) Gülhaş N.; Demirbilek S.; Öztürk E.; But A.K.; Do?an Z.; Ersoy M.Ö.Aim: Anaesthetic needs are different between female and male adults. The effect of fetal sex on maternal local anaesthetic requirements has not been examined in detail. The aim of this study was to assess if fetal sex was associated with maternal regional anaesthetic requirements in elective cesarean sections. Material and Methods: After obtaining hospital Ethics Committee approval, 46 elective cesarean sections in ASA class I and II patients were reviewed. After a pre-load of 10 mL kg-1 Ringer Lactate, combined spinal epidural anaesthesia was administered. Spinal block was performed with 7.5 mg hyperbaric bupivacaine. If the sensory block didn't reach the T 4 dermotome 5 mL of 7.5% ropivacaine was administered through the epidural catheter. Time to reach T4 sensory block and required local anaesthetic doses were recorded. Results: Sensory block levels of mothers with female fetuses were statistically higher at 5 min after subarachnoid injection (p<0.05). Additionally time to reach T4 was shorter and required less ropivacaine in the group with female fetuses (p<0.05). Conclusion: The results of this trial, suggest that mothers with female fetuses have reduced regional anesthetic requirements for Cesarian section. Further studies are warrated.Öğe The effects of intra-operative low-dose dexmedetomidine infusion on postoperative pain in patients undergoing septorhinoplasty(Maney Publishing, 2006) Cicek M.; Yucel A.; Gedik E.; Sagir O.; But A.K.; Ersoy M.O.Study objective: To determine the effects of intra-operative low-dose dexmedetomidine infusion on postoperative morphine consumption, pain, sedation and patient satisfaction in patients undergoing septorhinoplasty. Method: Fifty adult patients were randomised to receive either dexmedetomidine (a loading dose of 1 ?g kg-1 for the first ten minutes and a maintenance dose of 0.2 ?g kg-1 h-1 afterwards, Group D) or 0.9% saline in the same manner (Group C) after induction of anaesthesia. At the end of the operation, the infusions were discontinued. After extubation, patient controlled analgesia was started intravenously. Results: Patients in Group D consumed 47% less morphine than patients in Group C during the first 24 h and had a lower cumulative morphine consumption at all times after starting patient controlled analgesia (7.08 mg vs. 8.56 mg at 2 h (p < 0.05), 10.84 mg vs. 14.0 mg at 4 h (p < 0.05), 13.56 mg vs. 18.28 mg at 6 h (p < 0.05) and 17.96 mg vs. 33.72 mg at 24 h (p < 0.05), respectively in Group D and Group C). Visual analogue scale scores for pain were higher at all times in Group C than in Group D (p < 0.05). Sedation scores were higher in Group D than in Group C at 30 min after starting patient controlled analgesia (p < 0.05). Patient satisfaction scores were higher at all times in Group D than in Group C (p < 0.05). Conclusions: Intra-operative low-dose dexmedetomidine infusion during septorhinoplasty decreases postoperative morphine consumption, provides effective postoperative pain relief and achieves better patient satisfaction without increased adverse effects. © 2006 VSP.Öğe The effects of sevoflurane and propofol on hepatic and renal functions in elderly patients(2003) But A.K.; Durmuş M.; Köro?lu A.; Yücel A.; Ülger H.; Ersoy M.O.In this study, we aimed to compare the effects of sevoflurane and propofol on hepatic and renal functions in patients more than 65 years of age. 46 patients, ASA physical status I-II, more than 65 years of age, undergoing elective surgery were taken into the study. Anaesthesia was induced with 66% N2O and 7% sevoflurane in the group S (n=23) and iv.1-2 mg kg-1 propofol approximately within 30 seconds in the group P (n=23). Anesthesia was maintained with 1-4% sevoflurane and 66% N2O in group S, 2-10 m kg-1 hr1 propofol and 66% N2O in group P. Blood sample was taken from all patients preoperatively and postoperative 1, 3, 5-7 and 14.days to measure the total bilirubine (T.Bil.), aspartate aminotransferase (AST), g-glutamyl transferase (GGT), lactate dehydrogenase (LDH), alkalane phosphatase (ALP), creatinine (cre) and blood urea nitrogen (BUN). At the same time periods, creatinine clearences (K.Klr) were calculated, and protein and glucose qualitative analyses were done in urine. In Group S, AST and GGT at all postoperative periods, ALT and LDH in postoperatively 1 and 5-7th days, ALP and K.Klr in postoperatively 3rd day were measured significantly higher than preoperative basal values. In Group P, T.bil in postoperative 1st day, AST in postoperative 14th day, ALT and ALP at all postoperative periods, LDH in postoperative 1st and 3rd days were measured significantly higher than preoperative basal values. As a result; we concluded that sevoflurane and propofol anesthesia in ASA I-II elderly cases undergoing elective surgery, renal functions were preserved for both of the groups, but although there was no statistically significant difference between two groups, minimal transient hepatic dysfunctions were signifantly more in sevoflurane group.Öğe The Effects of Sevoflurane and Propofol on Induction, Maintenance and Recovery in Elderly Patients(2003) But A.K.; Durmuş M.; To?al T.; Gedik E.; Yücel A.; Özcan Ersoy M.In this study, we aimed to compare the effects of sevoflurane and propofol on induction, maintenance and recovery in elderly patients. Forty patients, ASA class I-II, more than 60 years of age, undergoing elective surgery that last between 2-4 hours were taken into the study. Anaesthesia was induced with 66 % N2O and 7 % sevoflurane in the group S (n=20) and 1-2 mg kg -1 propofol approximately within 30 seconds in the group P (n=20). In the two groups; loss of consciousness, loss of eyelid reflex, time to intubation, adverse effects during induction, heart rate (HR) and mean arterial pressure (MAP) after first, third and fifth minutes of induction were recorded. Maintenance of anaesthesia was provided with 66 % N2O and 1-4 % sevoflurane in group S, 2-10 mg kg -1 h-1 propofol and 66 % N2O in group P. HR and MAP values were determined after first minutes of intubation until the end of the operation. At the end of operation after discontinuation of anaesthetic agents, times to extubation, eye opening, verbal response, orientation and Aldrete score >8 were recorded. The only difference is that induction time was shorter significantly in the group P (p<0.05). Sevoflurane and propofol recovery times and postoperative complications were similar in ASA I-II, elderly cases undergoing elective surgery. Although its hypotensive effect was prominent, induction was faster with propofol. We concluded that both of sevoflurane and propofol can be used safely for ASA I-II elderly patients, if the dose of propofol decreased and given slowly.Öğe The efficacy of remifentanil combined with either propofol, sevoflurane or desflurane during controlled hypotension(2004) Demirbilek S.; Gülhaş N.; Öztürk E.; But A.K.; Aslan Ü.; Ersoy M.Ö.The aim of this study was to compare the effects of a combination of remifentanil with propofol, desflurane or sevoflurane on intraoperative controlled hypotension, quality of the surgical field and recovery characteristics in patients undergoing nose surgery. ASA physical status I, 18-47 yr of age, 54 patients were randomly divided to three groups and received remifentanil 1?g kg-1 as a bolus dose followed by a continuous infusion of 0.25 ?g kg-1 min-1. In propofol group, anesthesia was induced 1.5-2 mg kg-1 of propofol and maintained with a continuous infusion of 100-200 ?g kg-1 min-1. In sevoflurane group, anesthesia was induced with 7% sevoflurane in 100% oxygen, and was maintained with 1-2% sevoflurane and air in oxygen. In desflurane group, anesthesia was induced 1.5-2 mg kg-1 of propofol and maintained with 4-6% desflurane and air in oxygen. The study drug titration was adjusted to keep the systolic blood pressure (SBP) between 80-100 mmHg during surgery. During controlled hypotension, while SBP was significantly lower in desflurane and sevoflurane groups than in propofol group, mean blood pressure (MBP) was significantly lower in sevoflurane group than in other groups (p<0.05). Supplemental hypotensive agent was administered to 2 patients in propofol group and 1 patient in desflurane group. After extubation, MBP and heart rate (HR) significantly increased in propofol group, HR significantly increased in sevoflurane group, SBP, MBP and HR significantly increased in desflurane group according to preinduction values (p<0.05). Estimated blood loss and surgical field score was similar in all three groups. The time to extubation and early recovery was significantly shorter in desflurane group than in sevoflurane and propofol groups (p<0.05). We concluded that since all three anesthetic techniques provided hemodynamic stability and good visualization of the surgical field, they may be used for controlled hypotension management. However, sevoflurane-remifentanil combination may be preferable, because it did not cause any increase in blood pressure after extubation.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, Hepatorenal and Postoperative Effects of Desflurane-Fentanyl and Midazolam-Fentanyl Anaesthesia in Coronary Artery Bypass Surgery(2004) But A.K.; Durmuş M.; Toprak H.I.; Öztürk E.; Demirbilek S.; Ersoy M.O.In this study, we aimed to compare the hemodynamic, hepatorenal and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anaesthesia during coronary artery bypass surgery. Sixty patients undergoing elective coronary artery bypass surgery with ejection fraction of more than 45% were included in the study. Patients were randomly divided into two groups as desflurane (Group D, n=30) and midazolam (Group M, n=30). Anaesthesia was induced with etomidate, 0.2 mg kg-1 and fentanyl, 5 ?g kg -1 in Group D and with midazolam, 0.1-0.3 mg kg-1 and fentanyl, 5 ?g kg-1 in Group M. For the maintenance of anaesthesia; desflurane, 2-6% and fentanyl, 15-25 ?g kg-1 were given in group D and infusion of midazolam at a rate of 0.1-0.5 mg kg -1 hr-1 and fentanyl at a rate of 15-25 ?g kg -1 were used in group M. Heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, left ventricle stroke work index and right ventricle stroke work index were measured before induction (t0), after induction (t1), after intubation (t2), after incision (t3), after sternotomy (t4), before cardiopulmonary bypass (t5), after protamine administration (t6) and at the end of the surgery (t7). Blood samples were taken to measure total bilirubine, aspartate amino transferase, gamma glutamyl transferase, lactate dehydrogenase, alkalane phosphatase, creatinine and blood urea nitrogen just before induction and at the 1st 4th and 14th days of postoperative period. In conclusion; intraoperative hemodynamic responses were similar in both of the groups and transient hepatic and renal dysfunction were observed in the postoperative period in both groups. The extubation and ICU discharge time were found to be shorter in the desflurane-fentanyl group.Öğe Induction of anaesthesia in coronary artery bypass graft surgery in elderly patients: Sevofluran-fentanyl versus midazolam-fentanyl(2006) But A.K.; Gedik E.; Yücel A.; Erdil F.; Nisano?lu V.; Durmuş M.; Ersoy M.Ö.We designed this study to compare the effects of sevoflurane-fentanyl and midazolam fentanyl during anesthetic induction in elderly patients in coronary artery bypass graft (CABG) surgery. Forty patients aged more than 65 years who underwent elective CABG surgery were included in this study. Anaesthesia was induced with sevoflurane 6% within 100% oxygen in Group S (n=20) and with midazolam, 0.2 mg kg-1, in Group M (n=20). Both techniques were supplemented by fentanyl, 5 ?g kg-1, and muscle relaxation was obtained with cis-atracurium, 0.1 mg kg-1. Time to loss of the consciousness, loss of eyelash reflex and intubation were recorded during induction in both of the groups. Heart rate and mean arterial blood pressure were recorded at baseline (T0), post-induction (T1), pre-intubation (T2), from the first minute with two-minute intervals for five minutes in post-intubation period (T3,T4,T5), post-incision (T6) and post-sternotomy (T7). Central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, systemic vascular resistance index, and pulmonary vascular resistance index were measured at T0, T1, T3, T6, and T7. Patient's satisfaction scores were obtained postoperatively. We concluded that inhalation induction with sevoflurane-fentanyl in elderly patients is fast, smooth and hemodynamically safe, similar to induction with intravenous agents in cardiac surgery.