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Öğe Comparison of Antioxidant Effects of Isoflurane and Propofol in Patients Undergoing Donor Hepatectomy(Elsevier Science Inc, 2015) Ucar, M.; Ozgul, U.; Polat, A.; Toprak, H. I.; Erdogan, M. A.; Aydogan, M. S.; Durmus, M.Background. The safety of healthy volunteer donors is one of the most important issues in living-donor liver transplantation. Use of the Pringle maneuver during donor hepatectomy can result in liver ischemia-reperfusion (IR) injury. The objective of this study was to examine the effects of isoflurane and propofol on IR injury caused by the Pringle maneuver during donor hepatectomy. Methods. A total of 70 American Society of Anesthesiology I-II donors aged 18-65 years who underwent hepatectomy were included in the study. The patients were randomly divided into 2 groups: propofol and isoflurane. Plasma superoxide dismutase (SOD), malondialdehyde (MDA), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) were measured before surgery (to) and after surgery (t(1)). Results. There were no statistically significant differences in demographic features, anesthesia, and times of surgery between the groups (P > .05). Plasma TAC levels at to and t(1) were significantly lower in the propofol group than in the isoflurane group (P < .05). OSI at t(1) was significantly higher in the propofol group than in the isoflurane group (P < .05). MDA levels were significantly higher in the propofol group than in the isoflurane group at to (P < .05). MDA levels level were significantly higher in the isoflurane group than in the propofol group at t(1) (P < .05). Conclusions. Propofol may have protective effects against IR injury caused by the Pringle maneuver during donor hepatectomy in living-donor transplantations. However, the effectiveness of propofol for clinical use needs to be investigated further.Öğe Comparison of preoperative and postoperative approaches to ultrasound-guided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy(Scientific Publishers India, 2017) Dirican, B.; Erdogan, M.; Ucar, M.; Uzgul, U.; Gulhas, N.; Kayhan, G.; Durmus, M.Background: Transversus Abdominis Plane (TAP) block produces more effective postoperative analgesia and significantly reduces consumption of postoperative opioids after various abdominal surgeries. It can be performed either preoperatively or postoperatively. Furthermore studies investigating the ideal period for TAP block administration are few. The objective of our study was to investigate, which period is more effective for administration of TAP block on postoperative analgesia in patients undergoing total abdominal hysterectomy. Methods: This prospective randomized controlled double-blind study was conducted with 60 patients between the ages of 18-65 and ASA class I-II who were scheduled to undergo total abdominal hysterectomy. Patients who received a TAP block with ultrasound guidance prior to the surgical procedure were referred to as Group 1, the TAP block procedure after surgery made up Group 2. The rest and movement period Visual Analog Score (VAS), sedation score, nausea, vomiting and the need for additional analgesics were recorded at 2, 4, 6, 12 and 24 hours postoperatively. Results: When Group 1 was compared with Group 2, the rest period pain scores were significantly lower in Group 2 at 2 and 4 hours (p< 0.05). In Group 2, the 24-hour morphine consumption was significantly lower than that of Group 1 (p< 0.05). Conclusion: Post-operative administration of an US guided TAP block in total hysterectomy patients significantly decreased pain scores in early periods and also reduced 24 hour morphine consumption when compared with preoperative administration of the block.Öğe Effect of alkalinisation of lignocaine for propofol injection pain: a prospective, randomised, double-blind study(Australian Soc Anaesthetists, 2013) Ozgul, U.; Begec, Z.; Erdogan, M. A.; Aydogan, M. S.; Sanli, M.; Colak, C.; Durmus, M.The aim of this study was to determine whether pretreatment with alkalinised lignocaine reduced the incidence and severity of pain during propofol injection. This prospective, randomised, double-blind study included 300 adult, American Society of Anesthesiologists physcial status I to II patients undergoing elective surgery. Patients were randomly allocated to one of three groups: Group L received 0.05 ml/kg of 1% lignocaine (5 ml normal saline + 5 ml 2% lignocaine), Group A received 0.05 ml/kg alkalinised lignocaine (5 ml 2% lignocaine + 1 ml 8.4% NaHCO3 + 4 ml normal saline), and Group S, the control group, was given the same amount of normal saline (NaCl 0.9%). All drugs were given as a bolus over 20 seconds before propofol administration. A blinded researcher assessed the patient's pain level using a four-point scale. The pain score [median (range)] and the incidence of pain in Group A (6%) was significantly lower than in groups L (41%) and S (88%, P <0.001). In addition, the pain score and the incidence of pain were found to be significantly different between Group L and Group S (P <0.001). The incidence of moderate and severe pain were greater in Group S when compared with groups A and L (P <0.001). Intravenous pretreatment with alkalinised lignocaine appears to be effective in reducing the pain during propofol injection.Öğe Effect of Preoperative Iron Deficiency in Liver Transplant Recipients on Length of Intensive Care Unit Stay(Elsevier Science Inc, 2013) Aydogan, M. S.; Ozgul, U.; Erdogan, M. A.; Yucel, A.; Toprak, H. I.; Durmus, M.; Colak, C.Liver transplant (LT) recipients often display iron deficiency preoperatively, which significantly increases the quantity of blood that needs to be transfused intraoperatively, A risk factor for a prolonged intensive care unit (ICU) stay. The aim of this retrospective study was to determine whether there was a clinically significant association between iron deficiency and the length of ICU stay, among 153 patients scheduled for OLT from September 2011 to June 2012. Patients were divided into 2 groups according to their baseline iron status: iron- deficient (ID) and non-ID (normal iron profile) cohorts. Iron deficiency was assessed on the basis of several parameters; transferrin saturation as well as serum iron, ferritin, soluble transferrin receptor, and C-reactive protein levels. We retrospectively analyzed the data regarding demographic and clinical features, preoperative laboratory values, intraoperative transfusions, and length of ICU stay. Patient demographic features and preoperative values were similar between the groups. Preoperative iron deficiency, which was diagnosed in 72 patients (58.6%), was associated with a greater intraoperative use of fresh frozen plasma and red blood cell transfusions (P = .0001). The median length of ICU stay after LT was longer among the ID versus the non-ID group (5 and 3 days per patient, respectively; P = .0001). Therefore, we have suggested that preoperative iron deficiency may be a prognostic factor for the length of ICU stay after LT.Öğe The effects of ephedrine on maternal hypothermia in caesarean sections: a double blind randomized clinical trial(Verduci Publisher, 2013) Gulhas, N.; Tekdemir, D.; Durmus, M.; Yucel, A.; Erdil, F. A.; Yologlu, S.; Ersoy, M. O.BACKGROUND: The purpose of the study was to investigate the effect of bolus and the combination of bolus and infusion of ephedrine on maternal hypotermia which are used for treating maternal hypotension under spinal anaesthesia. PATIENTS AND METHODS: 110 ASA I-II patients who developed maternal hypotension were included into the study. Spinal anaesthesia was performed with 12.5 mg heavy bupivacaine + 15 mu g fentanyl. Group I: Ephedrine bolus 5 mg plus ephedrine infusion, Group B: Ephedrine bolus 5 mg plus normal saline infusion. The systolic blood pressure was allowed to range between 20% from baseline values. Ephedrine solution infusion started after hypotension occurred (0.5 mg/minute). The body temperature under 35.5 degrees C was accepted as hypothermia. The newborns' rectal temperature was measured. Moreover, the Apgar scores, umbilical vein-arterial blood gas and acid-base status were evaluated. RESULTS: In Group I, the body core temperatures which were measured at 9, 18, 33, and 39th minutes were significantly higher than Group B (p < 0.05). The prevalence of maternal hypothermia in Group I was significantly lower than the Group B, which were as 65.5% (36/55) and 85.5% (47/55), respectively (p < 0.05). In Group I, the newborn rectal temperatures and the total dose of ephedrine were significantly higher than Group B (p < 0.05). In Group I, the systolic and mean blood pressures were higher than Group B (p < 0.05). CONCLUSIONS: As a result, we found that combined bolus and infusion of ephedrine for treating maternal hypotension prevents maternal and neonatal hypothermia during caesarean section under spinal anaesthesia compared to bolus administrations alone.Öğe Effects of Isoflurane and Propofol on Hepatic and Renal Functions and Coagulation Profile After Right Hepatectomy in Living Donors(Elsevier Science Inc, 2013) Ozgul, U.; Ucar, M.; Erdogan, M. A.; Aydogan, M. S.; Toprak, H. I.; Colak, C.; Durmus, M.We compared postoperative hepatic and renal functions and coagulation profiles in living donors undergoing right hepatectomy under isofiurane (n = 40) versus propofol (n = 40) anesthesia. After induction, anesthesia was maintained with isoflurane/air-O-2 (group I) or propofol/air-O-2 (group P) in addition to remifentanil and atracurium infusion in both groups. Aspartate aminotransferase, alanine aminotransferase, international normalized ratio (INR), activated partial thromboplastin time (aPTT), albumin, total bilirubin, blood urea nitrogen, creatinine, estimated glomerular filtration rate (GFR), platelet count, and hemoglobin levels were measured in the preoperative period, after end of the operation, and on the first, third, fifth and seventh postoperative days (PODs). INR was significantly increased on POD 3 and aPTT on POD 5 in group I compared with group P (P < .05). Albumin level was significantly lower in Group I on POD 1 and 3 (P < .05). GFR was significantly lower on POD 1 in the group I compared with group P (P < .05). The postoperative coagulation, GFR, and albumin values were superior following administration of propofol than isoflurane in donors who underwent living hepatectomy; however, both approaches were clinically safe, with no significant clinical difference.Öğe Effects of Preoperative Iron Deficiency on Transfusion Requirements in Liver Transplantation Recipients: A Prospective Observational Study(Elsevier Science Inc, 2013) Aydogan, M. S.; Erdogan, M. A.; Yucel, A.; Konur, H.; Bentli, R.; Toprak, H. I.; Durmus, M.The aims of this study were to determine the frequency of preoperative iron deficiency in adult living donor liver transplantation patients and to investigate its relationship with the need for intraoperative transfusion. Between September 1, 2011, and June 1, 2012, 103 patients scheduled for liver transplantation were included in this prospective study. Patients were divided into 2 groups according to baseline iron status: an iron-deficient group and a non deficient (normal iron profile) group. Iron deficiency was assessed on the basis of several parameters, including transferrin saturation, levels of ferritin, soluble transferrin receptor, C-reactive protein, and peripheral blood smear. Preoperative iron deficiency was diagnosed in 62 patients. Preoperative iron deficiency was associated with low preoperative hemoglobin levels (P = .01) and a high rate of intraoperative transfusion (P < .0001). Preoperative iron deficiency is prognostic factor for predicting intraoperative transfusion requirements. These findings have important implications for transfusion practices for liver transplant recipients.Öğe Effects of Two Different Techniques of Postoperative Analgesia Management in Liver Transplant Donors: A Prospective, Randomized, Double-Blind Study(Elsevier Science Inc, 2015) Aydogan, M. S.; Bicakcioglu, M.; Sayan, H.; Durmus, M.; Yilmaz, S.The aim of this study was the compare the donor patients who received intravenous (IV) morphine with patient-controlled analgesia (PCA) or epidural morphine during the early postoperative period who underwent liver transplantation. Forty patients were included in the study and randomly divided into 2 groups in a double-blinded manner. They were given IV morphine 5 mg (Group C), or epidural anesthesia adding morphine (2 mg; Group E) by epidural anesthesia technique starting 15 minutes before the estimated time of completion of surgery. All of the patients received PCA with IV morphine (Group C; PCA device was set to deliver 1 mg morphine with a lockout of 15 minutes and a 4-hour limit of 20 mg, and no continuous infusion) or epidural morphine (Group E; patient-controlled epidural analgesia [PCEA] device was set to deliver 0.5 mg morphine with a lockout of 30 minutes and a 4-hour limit of 10 mg, and no continuous infusion) and were followed up for 24 hours, and pain scores were evaluated by study nurses who were blinded to the study protocol. The visual analogue scale (VAS) scores at rest and at movement and morphine consumption at 12 and 24 hours after operation evaluation time points were significantly higher in Group E than those in Group C (P < .05). Furthermore, total morphine consumption in Group C was significantly higher than that in Group E (P < .05). Epidural morphine via PCEA was associated with decreased postoperative VAS scores and morphine consumption. These findings may be beneficial for managing postoperative analgesia protocols in liver transplant donor patients.Öğe Remifentanil without muscle relaxants for intubation in microlaryngoscopy: a double blind randomised clinical trial(Verduci Publisher, 2013) Gulhas, N.; Topal, S.; Kayhan, G. Erdogan; Yucel, A.; Begec, Z.; Yologlu, S.; Durmus, M.OBJECTIVES: We aimed to compare the effect of remifentanil without muscle relaxant with succinylcholine for intubation in microlaryngoscopy. PATIENTS AND METHODS: Eighty patients were randomly divided into two groups: Group R (n=40) and S (n=40) received remifentanil 4 mu g/kg intravenously or 1 mu g/kg respectively. Anesthesia was induced with 2 mg/kg propofol in both groups. Intubation was performed after bolus administration of 10 ml saline as a placebo or 1 mg/kg of succinylcholine in Group R and S respectively. Remifentanil infusion was initiated at 0.025 mu g/kg in each groups. RESULTS: Intubation conditions were similar in both groups. The mean arterial pressure (MAP) values at post-induction period were significantly lower in the Group S than in the Group R (p = 0.001). The requirement for ephedrine in Group R was found to be significantly lower than Group S (p = 0.023). Recovery times were significantly shorter (p = 0.001) and recovery scores were significantly higher (p = 0.021) in Group R. Time to patient could respond to commands was significantly longer in the Group S (p = 0.001). The surgeon's satisfaction score was significantly higher in Group R (p = 0.001). CONCLUSIONS: It was concluded that remifentanil without muscle relaxants provides similar intubating conditions as that provided by succinylcholine, and remifentanil is superior to succinylcholine with regard to haemodynamic stability and recovery duration.Öğe Sevoflurane alone and propofol with or without remifentanil for electroconvulsive therapy-a randomised, crossover study(Australian Soc Anaesthetists, 2013) Begec, Z.; Kayhan, G. Erdogan; Toprak, H. I.; Sahin, T.; Konur, H.; Colak, C.; Durmus, M.We compared the effectiveness of three anaesthetic regimens (propofol alone, propofol with remifentanil and sevoflurane alone), with respect to seizure duration and seizure quality in patients undergoing electroconvulsive therapy. Thirty-nine patients underwent a total of 234 electroconvulsive therapy treatments in this prospective, observer blinded, crossover study. Each patient received either propofol 1 mg/kg alone (Group P), propofol 0.5 mg/kg and remifentanil 1 mu g/kg (Group R), or sevoflurane alone 6% (Group S) for their initial electroconvulsive therapy session. The patients subsequently received an alternative regimen in their next session, such as from propofol 1 mg/kg alone to propofol 0.5 mg/kg and remifentanil 1 mu g/kg, from propofol 1 mg/kg alone to propofol 0.5 mg/kg and remifentanil 1 mu g/kg to sevoflurane alone 6%, or from sevoflurane alone 6% to a continuing alternation between drugs at each session, until their sixth session. Muscle paralysis was achieved with 1 mg/kg succinylcholine. Seizure duration, postictal suppression index, early and midictal amplitude were recorded. The mean motor and electroencephalogram seizure durations were significantly longer in Groups P and R compared to Group S (P <0.001). The postictal suppression index and early and midictal amplitude values were not significantly different among the groups. These findings indicate that the three anaesthetic regimens had similar effects on seizure quality parameters, although sevoflurane was associated with shorter seizure durations than propofol or propofol-remifentanil.
