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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 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 Effects of 2 Different Doses of Pregabalin on Morphine Consumption and Pain After Abdominal Hysterectomy: A Randomized, Double-Blind Clinical Trial(Elsevier, 2011) Yucel, Aytac; Ozturk, Erdogan; Aydogan, M. Said; Durmus, Mahmut; Colak, Cemil; Ersoy, M. OzcanBACKGROUND: Pregabalin has a similar pharmacologic profile to that of its developmental predecessor gabapentin but has shown greater analgesic activity in rodent models of neuropathic pain. OBJECTIVE: The objective of the study was to compare the effects of 2 different doses of pregabalin and placebo on postoperative pain and morphine consumption. METHODS: Ninety patients who underwent abdominal hysterectomy were included in the study and randomly divided into 3 groups in a doubled-blinded manner. They were given 150 mg of pregabalin (group P300, n = 30), 300 mg of pregabalin (group P600, n = 30), or placebo capsules (group C, n = 30) 4 hours before the induction of anesthesia; they received a second dose of the drug 12 hours postoperatively. Morphine consumption, nausea, and vomiting, visual analogue scale-pain intensity (VAS-PI), sedation scores, and dissatisfaction scores were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 hours after operation. RESULTS: Morphine consumption at 24 hours was 40.80 (3.42) mg, 33.79 (5.77) mg, and 46.97 (6.67) mg in groups P300, P600, and C, respectively (P < 0.001). VAS-PI scores at movement and at rest in the PACU and at 2, 4, and 6 hours decreased in group P600 (P < 0.01). In the PACU and at 2, 4, and 6 hours, the sedation scores were increased in group P600 compared with the scores in group C (P < 0.001, P < 0.001, P = 0.01, P = 0.006, respectively). Patient satisfaction was higher in group P600 than in group C for all time points (P < 0.001, P < 0.001, P < 0.001, P = 0.001, P < 0.001, respectively). There were no statistically significant differences between the groups for side effects such as nausea, vomiting, and dizziness (P = 0.58). CONCLUSIONS: Pregabalin at a total dose of 600 mg, administered before operation and at 12 hours postoperatively after abdominal hysterectomy, reduced morphine consumption and pain intensity and increased patient satisfaction. No significant differences in side effects were observed between the study groups. (Curr Ther Res Clin Exp. 2011;72:173-183) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.Öğe Obstetric admissions to the intensive care unit in a tertiary referral hospital(W B Saunders Co-Elsevier Inc, 2010) Togal, Turkan; Yucel, Neslihan; Gedik, Ender; Gulhas, Nurcin; Toprak, H. Ilksen; Ersoy, M. OzcanPurpose The present study was conducted to evaluate the obstetric admissions to the intensive care unit (ICU) in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome Materials and Methods All of the obstetric patients who seeked care for delivery at the emergency department and who were admitted to the ICU between January 2006 to July 2009 were retrospectively identified The Simplified Acute Physiology Score (SAPS II) was calculated and the maternal mortality rate was estimated for each patient The mean SAPS II scores and the mean estimated maternal mortality rates for the surviving patients and the nonsurviving patients were compared Results Seventy-three obstetric patients were admitted to the ICU There were 9 maternal deaths and 24 fetal deaths For the surviving group of patients, the mean SAPS II score was 34 and estimated maternal mortality rate was 20%, whereas for the nonsurviving group of patients the SAPS II score was 64 and estimated maternal mortality rate was 73% The difference between the surviving group of patients and the nonsurviving group of patients was statistically significant regarding both the mean SAPS II scores and the mean estimated maternal mortality rates Conclusions Pregnancy induced hypertensive disorders and hemorrhage appear as the major risk factors influencing maternal outcome in obstetric patients Considering that the use of the SAPS II scores have enabled the reliable estimation of the mortality rates in the present study, the attempts at defining the focus of care for the obstetric patients who bear the major risk factors and who are admitted to the ICU should be carried out under the guidance of the ICU scoring systems such as the SAPS 11 (C) 2010 Elsevier Inc All rights reservedÖğe 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 Retrospective Analysis of Intoxication Patients Admitted to Intensive Care Unit: Evidence Based Management vs Personal Experience(Drunpp-Sarajevo, 2011) Ertan, Cem; Gedik, Ender; Yucel, Neslihan; Akgun, F. Sinem; Aslan, Sibel; Togal, Turkan; Ersoy, M. OzcanObjective: Intoxication is a major problem in emergency departments (ED). Patients shall either be hospitalized or discharged after ED care. This decision requires a thorough evaluation of the patients' risk of mortality and cost effective approach. Aim of this study was to define characteristics of our poisoning patients and appropriateness of their hospitalization decisions to ICU. Methods: Adult patients hospitalized to ICU following admittance to ED within three years period with acute poisoning were retrospectively enrolled. Demographics, poisoning data, former psychiatric history, ICU follow up information, outcome at hospital discharge and in the first 28 days and predominant pathological clinical findings were recorded. Results: Our study group accounted for 3.6 per 1000 ED visits and 16.6% of ICU admittance. Mean age of the patients was 30.21 +/- 12.83 years, F/M ratio was 2.2 and 48.9% of the patients were married. Foremost encountered substances were psychoactive drugs (39.4%). 94.2% of our patients were suicidal and 39.8% of them used two or more agents. Intubation and mechanical ventilation was performed for 14 patients (5.1%), mean duration for intubated follow up was 7.07 days. Only two patients with caustic ingestions were dead (0.8%). Mean hospitalization period was 4.78 +/- 8.77 days and mean ICU bed use was 2.62 +/- 3.18 days. Total hospitalization duration was <= 48 hours 198 (72.3%) patients and > 48 hours in 76 patients (27.7%). Conclusion: We speculate that, high rates of early discharge from ICU may support the necessity of a solid ICU admission criterion.
