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  • Küçük Resim Yok
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    Anaesthetic management of an infant with Conradi's syndrome
    (Blackwell Publishing Ltd, 2003) Hascalik, M; Togal, T; Doganay, S; Ersoy, MO
    [Abstract Not Available]
  • Küçük Resim Yok
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    Antioxidant properties of propofol and erythropoietin after closed head injury in rats
    (Pergamon-Elsevier Science Ltd, 2005) Ozturk, E; Demirbilek, S; But, AK; Saricicek, V; Gulec, M; Akyol, O; Ersoy, MO
    Reactive oxygen species play a role during brain injury due to closed head trauma. Enzymatic or nonenzymatic antioxidants may protect brain tissue against oxidative damage. The present study was performed to assess the changes of endogenous indices of oxidative stress in serum from rats subjected to head trauma and whether treatment with propofol and/or erythropoietin (EPO) modifies the levels of endogenous indices of oxidative stress. For these purposes, female Wistar Albino rats were divided into five groups: nontraumatic sham group, trauma performed control, trauma with propofol (i.p.), trauma with EPO (i.p.) and trauma with propofol and EPO performed study groups. At the end of the experimental procedure, blood was taken by cardiac puncture to determine superoxide dismutase (SOD) and xanthine oxidase (XO) activities as well as malondialdehyde (MDA) and nitric oxide (NO) levels in serum. Serum NIDA level of control traumatic brain injury (TBI) group was significantly higher than sham operation group (p < 0.012). Serum NIDA levels in propofol, EPO and propofol+EPO groups were found to be decreased in comparison with control group (p < 0.039, p < 0.030 and p < 0.018, respectively). Serum NO level was found to be increased in TBI group, but difference was not statistically significant when compared to sham-operated group (p=0.092). Propofol, EPO and propofol+EPO administration efficiently reduced serum NO levels to reach sham-operated group (p < 0.002, p < 0.001 and p < 0.015, respectively). These results suggested that acute administration of both propofol and EPO altered the indices of oxidative stress similarly against brain injury due to trauma. (c) 2005 Elsevier Inc. All rights reserved.
  • Küçük Resim Yok
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    Comparison of propofol-alfentanil and propofol-remifentanil anaesthesia in percutaneous nephrolithotripsy
    (Cambridge Univ Press, 2005) Cicek, M; Koroglu, A; Demirbilek, S; Teksan, H; Ersoy, MO
    Background and objective: Percutaneous nephrolithotripsy (PCNL) is used for the fragmentation and removal of stones from the renal pelvis and renal calyceal systems. We compared the effects of propofol-alfentanil or propofol-remifentanil anaesthesia on haemodynamics, recovery characteristics and postoperative analgesic requirements during percutaneous nephrolithotripsy. Methods: Thirty non-premedicated patients were randomly allocated to receive either propofol-alfentanil (Group A) or propofol-remifentanil (Group R). The loading dose of the study drug was administered over 60 s (alfentanil 10 mu g kg(-1) or remifentanil 1 mu g kg(-1)) followed by a continuous infusion (alfentanil 15 mu g kg(-1) h(-1) or remifentanil 0.15 mu g kg(-1) min(-1)). Propofol was administered until loss of consciousness and maintained with a continuous infusion of 75 mu g kg(-1) min(-1) in both groups. Atracuriurn was given for endotracheal intubation at a dose of 0.5 mg kg(-1) and maintained with a continuous infusion of 0.4 mg kg(-1) h(-1) Mean arterial pressure heart rate, the total amount of propofol, time of recovery of spontaneous ventilation, extubation and eye opening in response to verbal stimulus and analgesic requirement were recorded. Results: In Group A, mean arterial pressure was higher at the first minute in the prone position, and during skin incision and lithotripsy, and heart rate was higher during skin incision and lithotripsy when compared with Group R (P < 0.05). The total amount of propofol did not differ between groups. Time of recovery of spontaneous ventilation, extubation and eye opening were significantly shorter in Group R than Group A (P < 0.05). Conclusions: Both propofol-remifentanil and propofol-alfentanil anaesthesia provided stable haemodynamics during percutaneous nephrolithotripsy, whereas propofol-remifentanil allowed earlier extubation.
  • Küçük Resim Yok
    Öğe
    Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia
    (Greenwich Medical Media Ltd, 2004) Demirbilek, S; Togal, T; Cicek, M; Aslan, U; Sizanli, E; Ersoy, MO
    Background and objective: In children, emergence agitation frequently complicates sevoflurane and desflurane anaesthesia. The effect of intravenous fentanyl 2.5 mug kg(-1) was examined on the incidence of emergence agitation in children who received desflurane or sevoflurane after midazolam premedication and intravenous thiopental induction. Methods: One hundred and twenty children (2-7 yr) undergoing adenoidectomy or tonsillectomy, or both, were studied. All children were premedicated orally with midazolam 0.5 mg kg(-1). After intravenous induction with thiopental and atracurium to facilitate endotracheal intubation, patients were randomly assigned to one of four groups: Patients in Groups I and 3 received physiological saline solution, whereas patients in Groups 2 and 4 received intravenous fentanyl 2.5 mug kg(-1) during induction. Anaesthesia was maintained with sevoflurane in Groups I and 2 and with desflurane in Groups 3 and 4. After discontinuation of the volatile anaesthetic, the times to tracheal extubation and response to verbal stimuli (emergence time), and emergence behaviours were recorded. Results: The time to tracheal extubation was significantly shorter in Groups 3 (5.2 +/- 1.7 min) and 4 (6.4 +/- 2.1 min) than in Groups 1 (8.1 +/- 2.1 min) (P = 0.0001 and 0.006, respectively) and 2 (8.8 +/- 1.9 min) (P = 0.0001). The emergence time was significantly shorter in Group 3 (10.0 +/- 3.9 min) than in Groups 1 (13.8 +/- 4.9 min) (P = 0.017) and 2 (14.9 +/- 4.1 min) (P = 0.003). The incidence rate of severe agitation was 13% in Groups 1 and 3, and 7 and 10% in Groups 2 and 4, respectively (P > 0.05). Conclusions: After midazolam premedication and intravenous induction of anaesthesia with thiopental, administration of intravenous fentanyl 2.5 mug kg(-1) did not provide any clinically significant benefit on emergence agitation in children who receive sevoflurane or desflurane anaesthesia.
  • Küçük Resim Yok
    Öğe
    The effects of magnesium sulphate on sevoflurane minimum alveolar concentrations and haemodynamic responses
    (Cambridge Univ Press, 2006) Durmus, M; But, AK; Erdem, TB; Ozpolat, Z; Ersoy, MO
    Background and objective: Magnesium administered before anaesthesia induction results in a significant reduction in intravenous anaesthetic consumption. The purpose of this study was to evaluate whether the dose of intravenous magnesium sulphate reduces the minimum alveolar anaesthetic concentration of sevoflurane for endotracheal intubation (MACE,) and skin incision (MAC), and attenuates haemodynamic responses. Methods: We studied 60 patients who were scheduled for elective surgery. Patients were not premedicated before induction of anaesthesia and were randomly assigned to receive intravenous saline 0.9% (Group I, n = 20) or magnesium sulphate 30 mg kg(-1) bolus + 10mg kg(-1) h(-1) continuous infusion (Group II, n = 20) or 50 mg kg(-1) bolus + 10 mg kg(-1) h(-1) continuous infusion (Group III, n = 20). Results: Median and 95% confidence limits for sevoflurane MAC(EI) were 2.68 (2.48-2.85), 2.88 (2.70-3.06) and 2.96 (2.70-3.16), and for sevoflurane MAC were 2.08 (1.76-2.40), 2.26 (2.08-2.47) and 2.40 (2.19-2.68) in Groups 1, 11 and 111, respectively. The differences in MACEI and MAC among groups were not statistically significant, except Group III in MAC study (P < 0.05). Mean arterial pressures and heart rate did not increase in Groups II and III after endotracheal intubation and skin incision. Conclusions: Magnesium sulphate administered before induction of anaesthesia increases MAC of sevoflurane and reduces cardiovascular responses to intubation.
  • Küçük Resim Yok
    Öğe
    The effects of methylene blue on lung injury in septic rats
    (Karger, 2006) Demirbilek, S; Sizanli, E; Karadag, N; Karaman, A; Bayraktar, N; Turkmen, E; Ersoy, MO
    Purpose: We aimed to investigate the effects of methylene blue (MB) on NO production, myeloperoxidase (MPO) activity, antioxidant status and lipid peroxidation in lung injury during different stages of sepsis in rats. Material and Methods: Rats were randomly divided into 4 groups (n = 20): group C, sham operated; group CMB, sham operated and receiving MB (25 mg/kg, i.p.); group S, sepsis; group SMB, sepsis and receiving MB (25 mg/ kg, i.p.). Sepsis was induced by cecal ligation and puncture (CLP). The MB dose was administered after CLP. Each group was subdivided into two subgroups (n = 10) which were sacrificed at 9 or 18 h after the surgical procedure. The levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX) and MPO activity, total nitrite/nitrate and malondialdehyde (MDA) in the lung tissue were measured. Lung injury was graded from 1 (injury to 25% of the field) to 4 (diffuse injury) by the pathologist. Results: In group SMB, while SOD and CAT increased in both early and late sepsis periods, GSH-PX increased significantly only in the early sepsis period when compared with group S. Increase in lung MPO activity after CLP-induced sepsis was prevented by MB administration. MB significantly decreased to nitrite/nitrate and MDA levels both in early and late sepsis periods when compared with group S (p < 0.05). Group S showed a marked increase in neutrophil infiltration into the interstitial space and thickening of the alveolar septa, whereas the alveolar damage score was lower in the SMB group (p < 0.05). Conclusion: MB reduced the MPO activity and lipid peroxidation by both decreasing oxidative stress and NO overproduction in the lungs, which resulted in the attenuation of lung injury after CLP-induced sepsis in rats. Copyright (c) 2006 S. Karger AG, Basel.
  • Küçük Resim Yok
    Öğe
    The effects of single-dose dexamethasone on wound healing in rats
    (Lippincott Williams & Wilkins, 2003) Durmus, M; Karaaslan, E; Ozturk, E; Gulec, M; Iraz, M; Edali, N; Ersoy, MO
    Dexamethasone effectively decreases the incidence of nausea and vomiting among pediatric and adult patients. In this study, we evaluated the effects of single-dose dexamethasone on wound healing in a prospective, randomized, experimental animal model. Anesthesia was induced with thiopental 100 mg/kg intraperitoneally. Dexamethasone 1 mg/kg was administered intraperitoneally in a dexamethasone group, and physiological saline was administered in a control group. Collagenization, epithelization, and fibroblast content were significantly less in the dexamethasone group compared with the control group (P values of 0.002, 0.041, and 0.023, respectively). The vascularity and the degree of inflammatory cells were more intense in the dexamethasone group compared with the control group (P values of 0.023 and 0.002, respectively). The white blood cell count was similar in the control (7.84 +/- 2.09) and dexamethasone (6.98 +/- 2.12) groups. The mean hydroxyproline level was 0.72 +/- 0.13 mg/g in the dexamethasone and 1.03 +/- 0.19 mg/g in the control group. Hydroxyproline levels were significantly less in the dexamethasone group (P = 0.001). We conclude that dexamethasone at I mg/kg may have negative effects on wound healing.
  • Küçük Resim Yok
    Öğe
    Hemodynamic, hepatorenal, and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anesthesia in coronary artery bypass surgery
    (W B Saunders Co-Elsevier Inc, 2005) But, AK; Durmus, M; Toprak, HI; Ozturk, E; Demirbilek, S; Ersoy, MO
    Objective: The purpose of this study was to compare the hemodynamic, hepatorenal, and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anesthesia during coronary artery bypass surgery. Design: Prospective study. Setting: University hospital. Participants: Sixty patients undergoing elective coronary artery bypass grafting surgery with ejection fraction more than 45%. Interventions: Anesthesia was induced with etomidate, 0.2 mg/kg, and fentanyl, 5 mu g/kg, in group D (n = 30) and with midazolam, 0.1 to 0.3 mg/kg, and fentanyl, 5 mu g/kg, in group M (n = 30). Anesthesia was maintained with desflurane, 2% to 6%, and fentanyl, 15 to 25 mu g/kg, in group D and midazolam infusion, 0.1 to 0.5 mg/kg/h, and fentanyl, 15 to 25 mu g/kg, in group M. Measurements and Main Results: Hemodynamic monitoring included a 5-lead electrocardiogram, a radial artery catheter, and a pulmonary artery catheter. Data were obtained before induction of anesthesia (t(0)), after induction of anesthesia (t(1)), after intubation (t(2)), after surgical incision (t(3)), after sternotomy (t(4)), before cardiopulmonary bypass (t(5)), after protamine infusion (t(6)), and at the end of the surgery (t(7)). Blood samples were obtained to measure total bilirubin, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase, alkaline phosphatase, creatinine, and blood urea nitrogen just before induction of anesthesia and at the first, fourth, and 14th days postoperatively. Conclusions: Intraoperative hemodynamic responses were similar in both groups, and transient hepatic and renal dysfunctions were observed in the postoperative period in both groups. The extubation and intensive care unit discharge times were found to be shorter in the desflurane-fentanyl group. (c) 2005 Elsevier Inc. All rights reserved.
  • Küçük Resim Yok
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    Hyperbaric bupivacaine affects the doses of midazolam required for sedation after spinal anaesthesia
    (Lippincott Williams & Wilkins, 2005) Toprak, HI; Ozpolat, Z; Ozturk, E; Ulger, MH; Sagir, O; Ersoy, MO
    Background and objective: Patients having spinal anaesthesia with hyperbaric bupivacaine may become sensitive to sedative drugs but no data exists about any dose-related effect of the local anaesthetic on the sedative requirement. We aimed to investigate whether hyperbaric bupivacaine dose in spinal anaesthesia has any effect on midazolam requirements. Methods: Sixty unpremedicated patients were allocated to three equal groups. Patients in Groups I and II received hyperbaric bupivacaine 0.5% 10 and 17.5 mg respectively for spinal anaesthesia and Group III was a control group without spinal anaesthesia. In Groups I and II, after the evaluation of sensory block, patients received intravenous midazolam I mg per 30 s until the Ramsay sedation score reached 3 (drowsy but responsive to command). In Group III, general anaesthesia was induced after sedation score had reached 3 using midazolam. The total dose of midazolam (mg kg(-1)) given to each patient, the level of sensory block and complications were recorded. Results: The level of sensory block was higher in Group II (T7) than Group I (T9) (P < 0.01). The doses of midazolam were 0.063 mg kg(-1) in Group I, 0.065 mg kg(-1) in Group II and 0.101 mg kg(-1) in Group III (P < 0.001). There was no correlation between level of sensory block and dose of midazolam in Group I (r = -0.293, P = 0.21) and Group II (r = 0.204, P = 0.39). Conclusions: Different doses of hyperbaric bupivacaine for spinal anaesthesia do not affect the midazolam requirements for sedation. However, spinal anaesthesia with hyperbaric bupivacaine with a maximum spread in the middle thoracic dermatomes may be associated with sedative effects and thus a reduced need for further sedation with midazolam.
  • Küçük Resim Yok
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    Oral clonidine premedication does not reduce postoperative vomiting in children undergoing strabismus surgery
    (Blackwell Munksgaard, 2003) Gulhas, N; Turkoz, A; Durmus, M; Togal, T; Gedik, E; Ersoy, MO
    Background: We evaluated the effect of oral clonidine on postoperative vomiting (POV) in children undergoing strabismus surgery. Methods: Eighty ASA physical status I children aged 3-12 years were randomly assigned to one of two groups in a double-blinded manner. One hour before surgery, each patient in the clonidine group (n=40) received clonidine 4 mug kg(-1) in apple juice 0.2 ml kg(-1) , and each of the controls (n=40) received apple juice 0.2 ml kg(-1) only. The protocol for general anesthesia was propofol-sevoflurane in N-2 O/O-2 . A paracetamol suppository was administered in each case to prevent postoperative pain. Patient responses during 0-48 h after anesthesia were recorded as complete (no POV, no antiemetic rescue required), retching, vomiting, or rescue antiemetic. Results: There were no significant differences between the clonidine and control groups regarding the number of patients with complete response (21 vs. 18, respectively) retching (10 vs. 14, respectively), vomiting (19 vs. 22, respectively), or rescue antiemetic (9 vs. 12, respectively) during the first 48 h. Conclusion: Oral premedication with clonidine 4 mug kg(-1) did not reduce the rate of POV in the children undergoing strabismus surgery.
  • Küçük Resim Yok
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    Remifentanil and acute intermittent porphyria
    (Lippincott Williams & Wilkins, 2002) Durmus, M; Turkoz, A; Togal, T; Koroglu, A; Toprak, HI; Ersoy, MO
    [Abstract Not Available]
  • Küçük Resim Yok
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    Remifentanil with thiopental for tracheal intubation without muscle relaxants
    (Lippincott Williams & Wilkins, 2003) Durmus, M; Ender, G; Kadir, BA; Nurcin, G; Erdogan, O; Ersoy, MO
    Tracheal intubation may be accomplished with remifentanil and a non-opioid IV anesthetic without a muscle relaxant. In this study, we evaluated in double-blinded, prospective, randomized manner the dose requirements for remifentanil with thiopental without muscle relaxant administration to obtain clinically acceptable intubation conditions and cardiovascular responses. After premedication with midazolam 0.03 mg/kg IV, 105 patients were randomized equally to one of three study groups, each receiving the following: remifentanil 2 mug/kg (Group 1), 3 mug/kg (Group 11), and 4 mug/kg (Group Ell). Remifentanil was administered over 30 s, and anesthesia was induced with thiopental 5 mg/kg. Tracheal intubation conditions were assessed by the anesthesiologist performing the intubation as: (a) excellent, (b) satisfactory, (c) fair, and (d) unsatisfactory. There were no statistically significant differences among groups regarding to demographic data. Blood pressure and heart rate did not increase in any group after accomplishing intubation. There was a significant improvement in intubation conditions between Groups I and 11, 1 and 111, and II and III (P < 0.001). We conclude that remifentanil 4 mug/kg administered before thiopental 5 mg/kg provided excellent or satisfactory intubation conditions in 94% of patients and prevented cardiovascular responses to intubation.
  • Küçük Resim Yok
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    Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results
    (Elsevier Sci Ltd, 2005) Koroglu, A; Demirbilek, S; Teksan, H; Sagir, O; But, AK; Ersoy, MO
    Background. We evaluated the sedative, haemodynamic and respiratory effects of dexmedetomidine and compared them with those of midazolam in children undergoing magnetic resonance imaging (MRI) procedures. Methods. Eighty children aged between 1 and 7 yr were randomly allocated to receive sedation with either dexmedetomidine (group D, n=40) or midazolam (group M, n=40). The loading dose of the study drugs was administered for 10 min (dexmedetomidine 1 mu g kg(-1) or midazolam 0.2 mg kg(-1)) followed by continuous infusion (dexmedetomidine 0.5 mu g kg(-1) h(-1) or midazolam 6 mu g kg(-1) min(-1)). Inadequate sedation was defined as difficulty in completing the procedure because of the child's movement during MRI. The children who were inadequately sedated were given a single dose of rescue midazolam and/or propofol intravenously. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Sp(o2)) and ventilatory frequency (VF) were monitored and recorded during the study. Results. The quality of MRI was significantly better and the rate of adequate sedation was higher in group D than in group M (P < 0.001). In group D, the requirement for rescue drugs was lower and the onset of sedation time was shorter than in group M (P < 0.001). MAP, HR and VF decreased from baseline during sedation in both groups (P < 0.001). Conclusions. Dexmedetomidine provided adequate sedation in most of the children aged 1-7 yr without haemodynamic or respiratory effects during MRI procedures.
  • Küçük Resim Yok
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    Small-dose capsaicin reduces systemic inflammatory responses in septic rats
    (Lippincott Williams & Wilkins, 2004) Demirbilek, S; Ersoy, MO; Demirbilek, S; Karaman, A; Gürbüz, N; Bayraktar, N; Bayraktar, M
    We investigated the influence of small- and large-dose capsaicin in modulating systemic inflammatory responses during different stages of sepsis in rats. Rats were divided into six groups: group C, control; group S, sepsis; group CLC, small dose of capsaicin (1 mg/kg subcutaneously); group SLC, small dose of capsaicin plus sepsis; group CHC, large dose of capsaicin (150 mg/kg subcutaneously); group SHC, large dose of capsaicin plus sepsis. Rats were made septic by cecal ligation and puncture (CLP). Each group was subdivided into two subgroups. The animals were killed at 9 or 18 h after CLP. Plasma concentrations of calcitonin gene-related peptide (CGRP), tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, and total nitrite/nitrate (NOx) were measured. Superoxide dismutase and malondialdehyde (MDA) were determined in liver, lung, and heart tissues. CGRP was increased in groups S, CLC, and SLC when compared with the other groups. In the SLC group, plasma concentrations of TNF-alpha, IL-6, NOx, and tissue MDA levels were reduced and IL-10 level was increased when compared with groups S and SHC 18 h after CLP (P < 0.05). Small-dose capsaicin treatment increased antiinflammatory IL-10 levels and attenuated the increases in proinflammatory cytokines, NOx, and tissue MDA in septic rats.
  • Küçük Resim Yok
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    The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: a preliminary study
    (Blackwell Publishing Ltd, 2003) Gulhas, N; Durmus, M; Demirbilek, S; Togal, T; Ozturk, E; Ersoy, MO
    Background : Laryngospasm is the most common cause of upper airway obstruction after tracheal extubation. Magnesium has a central nervous system depressant property, which contributes to the depth of anaesthesia. It also has calcium antagonist properties, which provide muscle relaxation. In this study, we aimed to determine the effect of magnesium on preventing laryngospasm. Methods : After approval of the Ethics Committee and informed parental consent, 40 patients, ASA I-II, aged 3-12 years, who were scheduled for tonsillectomy or/and adenoidectomy, were randomly divided into two groups. Anaesthesia was induced with sevoflurane, lidocaine 1 mg.kg(-1) , alfentanil 10 mug.kg(-1) , vecuronium 0.1 mg.kg(-1) and maintained with sevoflurane 2% and 60% nitrous oxide in oxygen. After intubation, patients in group I received 15 mg.kg(-1) magnesium in 30 ml 0.9% NaCl over 20 min. Patients in group II received 0.9% NaCl alone in the same volume. After reversal of neuromuscular blockade, all patients were extubated at a very deep plane of anaesthesia. The incidence of laryngospasm was determined until the time of discharge from the postanaesthesia care unit. Results : Although laryngospasm was not observed in group I, it was observed in five patients in group II (25%). The incidence of laryngospasm in group II was significantly higher than group I. The plasma magnesium concentrations were significantly higher in group I than group II. Conclusions : We found a significant decrease in the incidence of laryngospasm in paediatric patients receiving magnesium. It is suggested that the use of intravenous magnesium intraoperatively may prevent laryngospasm.

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