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    Comparison of Dexmedetomidine and Alfentanil during Middle Ear Surgery
    (Mediterranean Soc Otology & Audiology, 2011) Sahin, Fazilet; Deren, Serpil; Erdogan, Gulay; Ornek, Dilsen; Dikmen, Bayazit
    Background: We aimed to compare the effects of controlled hypotension with dexmedetomidine or alfentanil on hemodynamic parameters, surgeon satisfaction and bleeding in surgical field under N2O-free low-flow sevoflurane anesthesia in patients undergoing middle ear surgery. Materials and Methods: Forty patients, classified as ASA physical status I-II and candidates for middle ear surgery were randomly allocated into two groups by sealed-envelope method. Before induction Group D (n=20) received 0.1 mu g/kg/min dexmedetomidine for 10 minutes and Group A (n=20) received 20 mu g/kg alfentanil. Group D received 0.7 mu g/kg/hour maintenance dose of dexmedetomidine and Group A 1 mu g/kg/min alfentanil up until 30 minutes from the end of the surgery. All patients were had an induction with 6 mg/kg thiopental + 0.1mg/kg vecuronium bromide. Following intubation 3% sevoflurane was administered in a mixture of 2.0 L/min O-2 + 2.0 L/min air and this was followed by low-flow anesthesia to deliver 0.5 L/min O-2 + 0.5 L/min air. During the operation, controlled hypotension level was adjusted to have a systolic blood pressure of 80-90 mmHg and mean arterial pressure of 50-65 mmHg. Hemodynamic parameters were recorded with five minutes intervals. The surgeon, blinded to the study drugs, assessed amounts of bleeding in the operative field and surgeon satisfaction. Results: Achieving the desired hypotension levels happened later in Group D. At the stage of membrane placement, targeted mean arterial pressures were achieved in both groups. Three patients in Group D required short-term nitroglycerine infusion to reach the desired hypotension levels. The amounts of bleeding and surgeon satisfaction were equal in both groups. The return of hypotensive effect of dexmedetomidine was slower once it was stopped. In Group A, postoperative nausea and vomiting were frequently observed and 0.1 mg doses of naloxone were administered to four patients for two times after extubation. Conclusion: Although additional hypotensive agent required in dexmedetomidine group and desired hypotension levels were happened lately, there was no difference in the amount of bleeding, surgical view and surgeon satisfaction between dexmedetomidine and alfentanil.
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    Possible heart failure associated with pregabalin use: case report
    (Kare Publ, 2011) Erdogan, Gulay; Ceyhan, Dilek; Gulec, Sacit
    Pregabalin and gabapentin are widely used analgesic, anticonvulsant and anxiolytic agents as they are relatively reliable and easily tolerated. However, they may cause some side effects such as dizziness, somnolence, dose-dependent peripheral edema, and weight gain, which may cause patients to abandon their use. Furthermore, there are a few reports in the literature addressing elderly patients with serious chronic disease and cardiac history, who develop heart failure during pregabalin application. In this report, we present a patient with no cardiac history treated with 300 mg/kg pregabalin due to neuropathic pain, who developed peripheral and then central edema, which were determined after advanced investigations. After stopping pregabalin, the situation regressed. Then, peripheral edema developed associated with the recommended dose of gabapentin, which was used in place of pregabalin. Despite the lack of any published evidence, the New York Heart Association issued a warning about using caution when prescribing pregabalin to type III-IV heart failure patients. Though the effect mechanisms of pregabalin and gabapentin are not well known, the calcium channel relationship may lead to these side effects. In summary, we believe that pregabalin and gabapentin, which is mostly used nowadays, should be administered with care not only in patients with advanced cardiac pathology but also in all patients, due to the potential side effects.