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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 Anaesthesia for caesarean delivery in a pregnant with acute type B aortic dissection(2013) Kayhan G.E.; Gülhaş N.; Şahin T.; Özgül Ü.; Şanli M.; Durmuş M.; Ersoy M.Ö.About 50% of aortic dissections in women younger than 40 years occur during pregnancy; mostly in the 3rd trimester and postpartum period. Aortic dissection in pregnancy creates a serious mortality risk for both mother and the foetus. The ultimate goal is to ensure the safety of both the mother and the foetus. In such cases, the best method of anaesthesia for caesarean delivery is still controversial. The first aim of anaesthetic management is to reduce the effect of cardiovascular instability on the dissected aorta. Here, we report anaesthetic management of a 36 year-old patient who developed acute type B aortic dissection at the 30th gestational week and whom was scheduled for caesarean section. Since haemodynamic stability could not be achieved despite nitroglycerine and esmolol infusions, together with invasive arterial monitoring, the decision for caesarean delivery was taken. A team of Cardiovascular Surgeons and an operating room were prepared because of the risks of aortic rupture and haemodynamic collapse during operation. A combined-spinal epidural anaesthesia was administered using 5 mg hyperbaric bupivacaine and 20 ?g fentanyl given at the L3-4 spinal level in the lateral position. After achieving T4 sensorial level, the operation proceeded and a baby weighing 1432 grams was delivered in 4 mins with a median sub-umbilical incision. Epidural patient controlled analgesia was applied to the patient during follow-up with medical treatment at postoperative period. Application of combined-spinal epidural anaesthesia with a combination of low dose local anaesthetics and an opioid with additional doses for insufficient sensorial levels is a suitable method for pregnant women with acute type B aortic dissection. © 2013 by Turkish Anaesthesiology and Intensive Care Society.Öğe Anaesthesia induction with ketamine:Propofol combination (ketofol) in caesarean delivery(2013) Kayhan G.E.; Toprak H.I.; Aslan A.; Çolak Y.Z.; Gülhaş N.; Durmuş M.; Ersoy M.Ö.Objective: The aim of this study was to compare the maternal and foetal effects of ketamine:propofol (ketofol) combination with thiopental, used in anaesthesia induction for caesarean delivery. Methods: Eighty, 18-35 years-old parturients in ASA I-II class, who were admitted for caesarean delivery under general anaesthesia, were allocated to this prospective, double-blind, randomised study. Patients were divided into two groups according to thiopental (Group T) or ketofol (Group K) administration. In anaesthesia induction, 4 mg kg-1 thiopental for Group T, 1 mg kg-1 ketamin + 1 mg kg-1 propofol (ketofol) for Group K were administered. Haemodynamic effects, BIS values, foetal parameters in the perioperative period and postoperative pain levels and morphine consumption were evaluated. Results: There were no significant differences between groups with regard to demographic data. Heart rate values were lower in Group K than Group T and there were significant differences between values immediately after intubation and 15 min after intubation. There were no significant differences in systolic and diastolic blood pressures between the two groups. Apgar scores recorded at the 5th minute were higher in Group K, while there were no differences in the 1st minute scores between groups (p=0.01). Upon analyses of umbilical artery blood gas, pH values were higher in Group K (p=0.034). While pain scores were similar in groups, total morphine consumption for 24 hours was found to be higher in Group K (p=0.008). Conclusion: We believe that 1 mg kg-1 ketofol (1:1), when used for anaesthesia induction of caesarean delivery, may be a good alternative to thiopental in terms of maternal and especially foetal effects; however, patients need to be followed closely for postoperative analgesic requirements. © 2013 by Turkish Anaesthesiology and Intensive Care Society.Öğe Anesthetic management of two patients with Cornelia de Lange syndrome(2012) Özgül Ü.; Begeç Z.; Yücel A.; Erdo?an M.A.; Bucak N.; Ersoy M.Ö.Cornelia de Lange syndrome is a rarely encountered disorder that is thought to progress secondary to hypoplasia of mesenchyma. Growth and mental retardation, hirsutism, major malformations of cardiac, gastrointestinal, and musculoskeletal systems with dysmorphic facial features are accompanied with this syndrome. Anesthetic management of these patients may encounter problems such as difficult tracheal intubation, aspiration and hypersensitivity to drugs. We want to review the anesthetic management and literature of the Cornelia de Lange Syndrome in this case presentation.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 Antioxidant effects of midazolam, isoflurane and desflurane during coronary artery by-pass grafting surgery(2009) Öztürk E.; But A.; Toprak H.I.; Demirbilek S.; Güleç M.; Ersoy M.Ö.It has been suggested that the reactive oxygen species (ROS) have essential role in the pathogenesis of myocardial ischemia-reperfusion injury. ROS may cause cardiac problems such as myocardial stunning, tissue damage and reperfusion cardiac arrhythmias may occur during weaning from pump in coronary artery bypass grafting (CABG). The aim of this study was compare the effects of midazolam, isoflurane, and desflurarie on the oxidative stress and hemodynamic parameters during CABG. After standard anesthesia induction, ninety patients were randomly allocated to Group M (midazolam), Group 1 (isoflurane), Group D (desflurane). Blood samples were obtained from the retrograde cannula placed in the coronary sinus; just prior to connecting to the pump (T1) and 5 minute after the cross-clamp removal (T2). In group M, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and adenosine deaminase (ADA) significantly increased, and nitric oxide (NO) and malondialdehyde (MDA) decreased at the T2 compared to the T1 (p<0.05). In Group 1, SOD and ADA increased at the T2 compared to the T1. While NO and MDA decreased, ADA increased in Group D at the T2 in comparison with the T1 (p<0.05). GSH-Px was significantly higher in Group M than Group 1 and D at the T2 (p<0.05). Although ADA was lower at the T2 in Group M than Group 1 and D, but there was only statistically significant difference between Group M and D (p<0.05). Midazolam had greater stimulating capacity on the endogenous antioxidant system and may caused less cellular damage than isoflurane and desjlurane due to its effects on the ADA.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 Caudal block in paediatric surgery: A retrospective survey in 2262 patients(2005) Begeç Z.; Durmuş M.; Toprak H.I.; Köro?lu A.; Ülger H.; Ersoy M.Ö.; Özpolat Z.Aim: The caudal block is a common regional anaesthetic techniques in infant and children. Limited data regard complications have been reported. We reviewed the anaesthesia records of 2262 paediatric patients in whom caudal block was performed between June 1995-May 2004 in our institution and describe the associated morbidity and complications. Results: Anaesthesia was induced with inhalation agents in 1633 patients, and intravenous agents in 629 patients. Caudal blocks were obtained by administering 1 mL kg-1 of 0.25% bupivacaine in 1563 patients, 0.25% bupivacaine and 1% prilocaine in 400 patients, 0.25% bupivacaine and 0.5 mg kg-1 ketamine in 61 patients, 0.25% bupivacaine and 1 mg kg-1 fentanil in 106 patients, and 0.2% ropivacaine in 132 patients. Complications rates were not different between patients over 10 kg and ?10 kg. There were statistically significant differences regarding total complications, and subcutaneous infiltration and intravenous injection rates comparing 1-2 years residents with 2-3 years and 3-4 years residents and staff anaesthesiologists (p<0.05). Conclusion: We conclude that caudal block is an appropriate technique in paediatric patients scheduled for surgery below the umbilicus. Complication rates decrease after the first year of aneasthesia training.Öğe Comparison of fentanyl and ketamine addition to bupivacaine for caudal anesthesia in children(2004) Köro?lu A.; Gülhaş N.; Türköz A.; Erdem S.; Ersoy M.Ö.In our study, we aimed to compare the effects of fentanyl and ketamine addition to bupivacaine on the quality of anesthesia, level of sensorial block, duration of motor block, postoperative analgesic requirement and duration of postoperative analgesia for caudal anesthesia in children. One hundred twenty two patients aged between 1-8 years old undergoing inguinal hernia repair were included in the study. Mask anesthesia with sevoflurane was applied during intravenous catheter placement and propofol infusion 1-3mg kg-1 h-1 was given while performing caudal anesthesia and during the operation. In group I (n=43) 2mg kg-1 0.25% bupivacaine, in group II (n=40) 1?g kg-1 fentanyl and 2mg kg-1 0.25% bupivacaine, in group III (n=39) 0.5mg kg-1 ketamine and 2mg kg-1 0.25% bupivacaine was given. Mean blood pressure, heart rate, peripheral oxygen saturation, respiration rate, ETCO2 and total dose of propofol used were recorded. Onset time of block, levels of sensorial block, duration of motor block and postoperative analgesia, total analgesic amount and complications were recorded. Mean level of sensorial block was significantly higher in group II and III than group I. Analgesic requirement after operation was significantly lower in group III than group I. Duration of postoperative analgesia was significantly longer in group III than the other groups. As a conclusion, we decided that fentanyl or ketamine addition to bupivacaine does not affect the quality of caudal anesthesia, but ketamine decreased the analgesic requirement by extending duration of postoperative analgesia.Öğe Comparison of morphine usage in intravenous PCA and epidural PCA(2003) To?al T.; Şahin Ş.; Durmuş M.; Türköz A.; Köro?lu A.; Ayas A.; Ersoy M.Ö.The aim of this study is to compare morphine for postoperative pain management by using intravenous and epidural patient controlled analgesia (PCA), for analgesic efficacy and side effects. After ethical committee approval was obtained, thirty cases aged 30-65 years (ASA I-II) were divided randomly into two groups. Group I received epidural PCA as loading dose morphine 2 mg, basal infusion rate 0.2 mg/h, bolus dose 0.5 mg and lockout time 30 minutes. Group II received intravenous PCA as loading dose morphine 5 mg, basal infusion rate 0.3 mg/h, bolus dose 1 mg and lockout time 15 minutes. Standard general anaesthesia procedure was performed. Procedure was started just after the operation. The mean arterial pressure, heart rate, respiratory rate, Visual Analogue Scale (VAS) and sedation scores were recorded at the end of the operation and at 1st, 2nd, 4th, 8th, 12th, 16th, 20th, 24th hour after the operation. Total morphine consumption, the number of request, the bolus dose delivery rate and side effects were recorded at the end of postoperative 24th hour. During 24 hours, morphine consumption and bolus dose delivery rate was significantly lower in Group I and the number of the request was significantly lower in Group II. There was no statistical difference between the two groups in terms of efficacy and VAS during 24 hours, except for the 8th hour. The VAS rates were below 3, after 8th hour in groups. VAS 8 score was lower in Group I. VAS rates at the hours 1, 2, 4, 8, 12, 16, 20, 24 decreased significantly compared to the rates at the beginning in each of the groups. Sedation scores at 1st, 2nd, 4th and 8th hour in Group I was lower than Group II. Pruritis was higher in Group I. There was no significant statistical difference between the two groups in terms of heart rate, mean arterial pressure and respiratory rate. As a result we conclude that the usage of morphine for the postoperative pain management by epidural or intravenous PCA provide effective analgesia only by short lock-out time and appropriate loading and bolus close.Öğe The effect of body-mass index on the duration of spinal anesthesia(AVES İbrahim KARA, 2006) Gülhaş N.; Begeç Z.; Durmuş M.; Erdem T.B.; Yücel A.; Ersoy M.Ö.Aim: The purpose of our study was to examine the duration of spinal anaesthesia obtained with same volume of local anesthetics in patients who have different bodymass index (BMI). Materials and Methods: After the approval from the faculty ethical committee and patient informed consent, 90 patient (ASA I-II, 15-65 years-old) who have undergoing elective urological surgery were included in to the study. Patients had normal body weight (BMI= 20-25), excessive body weight (BMI- 25-30) and obese patients (BMI= 30-35) were divided in N, EW (Excessive weight) and O groups, respectively. Spinal block was achieved by 3 mL hyperbaric bupivacaine with a 25 G Quincke spinal needle through L4-L5. Following the spinal block, maximum sensory block level, the periods to reaching the maximum sensory block, to decline of the sensory block at two levels, the time of the motor block relief were recorded in each patient in two minutes intervals. Results: The time to two level decline of sensory block and the time of the motor block relief were longer significantly in Group EW and O than Group N (p<0.05). Although motor block relief time was similar between group EW and O, there was a significant difference between these groups regarding to two level declining time (p<0.05). 2nd and 4 th minute Bromage scores were higher in Group O than Group N and Group EW (p<0.05) Conclusion: We considered that the duration of the spinal anaesthesia obtained with same volume of local anaesthetics were lengthened parallel to BMI.Öğe The effect of ginger and ondansetron on nausea and vomiting after middle ear surgery(2003) Gülhaş N.; Durmuş M.; Köro?lu A.; Gedik E.; Noyan F.; Ersoy M.Ö.We aimed to compare the effects of orally administered ginger and ondansetron tablet on postoperative nausea and vomiting (PONV) in patients undergoing middle ear surgery. The patients received either 1gr Ginger [250 mg, 4 capsules (Group I, n=30)] with 30 mL water, ondansetron orally disintegrating tablet 8 mg with 30 mL water (Group II n=30) or only 30 mL water (Group III n=30) one hour before the operation in a randomized, double blind manner. The patients' nausea and vomiting episodes were evaluated between 0-1 th, 1-8th and 8-24th hour periods. Nausea occurred in 11 (36.6%), 2 (6.6%) and 3 (10%) patients during 0-1 hour and 6 (20%), 1 (3.3%) and 1 (3.3%) patients during 1-8 hour in Group I, II and, III, respectively. Nausea did not occurre in any patients during 8-24 hour. The incidence of nausea was significantly higher in Group I compared to Group II and III in 0-1 hour (p<0.05). In the first hour, vomiting occurred in 11 (36.6%), 2 (6.6%) and 3 (10%) patients in Group I, II and, III, respectively. 4 patients (13.3%) vomitted in Group I in 1-8 hours. None of the patients vomitted in Group II and III during this period. No patient vomitted during 8-24 hour period. The incidence of vomiting was significantly higher in the first hour in Group I when compared to Group II and III (p<0.05). We concluded that ondansetron orally disintegrating tablet does not change the incidence of PONV and Ginger increases PONV in middle ear surgery.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 effect of intra-abdominal insufflation pressure on liver function in adult patients undergoing laparoscopic cholecystectomy(2005) Özpolat Z.; Durmuş M.; Toprak H.I.; Öztürk E.; Temel I.; Ersoy M.Ö.Aim: The relation between age and the effect of laparoscopic cholecystectomy on hepatocellular integrity has not been evaluated. We aimed to compare conventional liver function tests in two groups of adults of differing age undergoing elective laparoscopic cholecystectomy. Materials and Methods: We studied 43 patients divided into two groups according to age: Group 1, age 18-60 years (n=22) and Group 2, over 65 years (n=21). All patients received general anesthesia. CO2 was used to insufflate the peritoneal cavity, and intraperitoneal pressure was maintained at 10-14 mmHg during cholecystectomy. Reverse Trendelenburg position was maintained after CO2 insufflation. Arterial blood was sampled before the induction of anesthesia, at the end of surgery, and 1, 3, 6 and 24h after surgery for determination serum alanine aminotransferase (ALT) aspartate aminotransferase (AST), alpha-glutathione S-transferase (alpha-GST), and ganima-glutamyl transpeptidase (GGT) concentrations. Results: Baseline values of alpha-GST were within normal limits in both groups. Alpha-GST increased significantly in two groups at the end of surgery and at 1st hour after surgery. The increase of alpha-GST in Group 2 was higher than Group 1. Alpha-GST returned to normal values at 3,6 and 24h after surgery in both groups. Alpha-GST returned to the preoperative value at 24th h after surgery in Group 1 but not in Group 2. Conclusion: We conclude that elderly patients undergoing laparoscopic cholecystectomy have more hepatocellular injury when intraperitoneal pressure is greater than 10 mmHg.Öğe Effect of intratechal morphine on postoperative stress response and postoperative analgesic requirements on cardiac patients in major abdominal surgery(2000) To?al T.; Türköz A.; Durmuş M.; Şahin S.; Yilmaz S.; Ersoy M.Ö.This study investigated the use of single dose intratechal (IT) morphine on cardiac patients undergoing major abdominal surgery and its effect on postoperative stress response, hemodynamic response and postoperative analgesic requirements. ASA class III 20 patients were randomized to receive either 10 ?g/kg of intratechal morphine or control group. Induction were performed by fentanyl 5 ?g/kg, thiopentone 2-4 mg/kg and vecuronium 0.08 mg/kg and anaesthesia was maintained by 33% N2O/O2 mixture with sevoflurane. There were no significant differences in the serum cortisol, glucose, BUN, creatinine, ALP, ALT, AST, CK, CK-MB concentrations recorded in the two groups pre and postoperatively. Cortisol, CK and CK-MB concentrations increased in both groups postoperatively. Plasma glucose concentrations increased in control group postoperatively. There were no significant differences of hemodynamic parameters between the two groups. Analgesic requirements of control group increased postoperatively comparing IT group. Three patients died postoperatively, other side effects were clinically insignificant. In conclusion IT morphine had no effect upon hemodynamic response, did not inhibit the stress response to surgery perioperatively on cardiac patients but we demonstrated the decrease of the postoperative analgesic requirements.Öğe The effect of lidocaine infusion on neurocognitive dysfuction after cardiopulmonary bypass(2003) Ilksen Toprak H.; Türköz A.; To?al T.; Özcan Y.; Durmuş M.; Öztürk E.; Ersoy M.Ö.Although technically, surgical, and pharmacological research to prevent neuropsychological (NP) dysfunction are ongoing, NP dysfunction after cardiopulmonary bypass (CPB) is among the most important causes of postoperative morbidity and mortality. In recent years lidocaine, which has being investigated for being its effects on cerebral protection, showed many side effects on central nervous system even at clinical doses. In this study, we investigated whether lidocaine at clinical doses increase the disturbances on cognitive functions after CPB. Twenty-three cases enrolled in this study with coronary artery disease were divided into two groups randomly. Just after the pump, the first group (group I) was received 100 mg IV bolus of lidocaine and 1 mg min-1 lidocaine infusion, and the other group (group II) received same amounts of saline solution. Infusions were stopped at postoperative 24th hour. Cases were evaluated by a psychiatrist who does mot know the groups of patients for NP functions by Wechsler Memory Scale-Revised Form with seven subtests, one day before (ti), 24 hours after operation (ts) and at postoperative 7th day (tt). There was a significant decrease in score of two subtests evaluated at ts compared with ti in group I and it was observed that total NP function scores at ts were significantly decreased compared to ti. Whereas, in group II, there was a significant decrease in only one subtest and there was no significant difference in comparison of total scores. In addition, when two groups were compared, decrease in logical memory score and total NP function score at ts were more significant in group I than in group II. It was thought that lidocaine used after CPB could increase postoperative NP dysfunction. Nevertheless, a psychometric test with wider content should be used and we think that our results should be supported by other studies.Öğe Effect of malnutrition on total intravenous anaesthesia in patients undergoing elective gastrointestinal surgery(2007) Çiçek M.; Turan Y.B.; Toprak H.I.; Köro?lu A.; Ersoy M.Ö.Aim: The effects of malnutrition on anesthesia induction, hemodynamics, recovery criteria, propofol consumption and complications were evaluated in patients undergoing elective gastrointestinal surgery. Material and method: Fifty adult patients (ASA I-III) were divided as well-nourished (n=24) and malnourished (n=26) after preanesthetic evaluation. For anesthesia induction, all patients recieved remifentanil (1 ?gr kg-1), 1 % propofol (until loss of consciousness and release of the object from the hand) and cisatracurium (0.1 mg kg-1). Patients were intubated 3 minutes afterwards. For maintenance, remifentanil 0.15 ?g kg-1 min -1, propofol 75 ?g kg-1 min-1 and cisatracurium 0.08 mg kg-1 h-1 were administered. Propofol dosage was adjusted according to hemodynamic changes. Age, weight loss in last 6 months, body weight, serum albumin level, intubation conditions, mean arterial pressure, heart rate, recovery criteria (spontaneous breathing, eye opening and extubation times), amount of propofol used and complications were recorded. Results: Mean age and weight loss were higher in malnourished patients when compared to well-nourished patients while body weight and albumin levels were lower (p<0.05). Mean arterial pressure at 20 and 30 minutes during the operation were higher in well-nourished patients (p<0.05). Heart rate was lower in well-nourished patients at 1 and 5 minutes during intubation and at 10 minutes during operation (p<0.05). The incidence of hypotension was higher in malnourished patients during anesthesia induction (p<0.05). Time to recovery of spontaneous breathing was shorter in well nourished patients (p<0.05), while eye opening and extubation times were similar. Conclusion: We propose that malnutrition might cause negative effects on blood pressure during anaesthesia induction. However, it does not alter intubation conditions, propofol consumption and recovery criteria.Öğe The effect of oral clonidine on postoperative nausea and vomiting in children undergoing strabismus surgery(2001) Gülhaş N.; Türköz A.; Bayramlar H.; Durmuş M.; Gedik E.; Da?lio?lu M.C.; Ersoy M.Ö.We aimed to investigate the effect of oral clonidine on postoperatory nausea and vomiting (PONV) in forty patients who underwent strabismus surgery. Patients were divided into two groups in this randomized and double blind prospective study. In Group I (n=20), patients were orally administered 4 ?g/kg clonidine within 0.2 mL/kg apple juice one hour before surgery. Group II, the control Group, were given only apple juice in same volume. Anesthesia was induced by atropine 0.02 mg/kg, lidocaine 2 mg/kg, propofol 3 mg/kg and vecuronium 0.1 mg/kg. Sevoflurane 2 % and N20 60 % in oxygen 40 % was used for maintenance The nausea and vomiting episodes were scored from 0 to 3 as follows: score 0: no nausea-vomiting; score 1: only nausea; score 2: some nausea-vomiting not needed treatment; score 3: severe vomiting needing treatment (metoclopramide 0.15 mg/kg). Nausea and vomiting was observed in five children in Group I (25 %) and in 8 children in Group II (40 %) (p<0.05) in first 6 hours of postoperative period. During first 48 hours, the rate of nausea and vomiting increased to 8 (40 %) and 12 (60 %) children in Group I and II, respectively (p<0.05). There was no statistically significant difference between two groups at other intervals. In conclusion clonidine which is given orally preoperatively reduced the rate of PONV in children who underwent strabismus surgery.Öğe The effect of the addition of clonidine to lidocaine during regional intravenous anaesthesia(2003) Durmuş M.; Tüköz A.; Gülhaş N.; Karaaslan E.; Ersoy M.Ö.Intravenous regional anaesthesia (IVRA), is a simple and convenient anaesthetic method that can be used in extremity surgeries for surgical analgesia. But absence of postoperative analgesic effect is an important disadvantage of this method. In this study, we aimed to evaluate the addition of clonidine to lidocaine on quality of peroperative analgesia in IVRA. After obtaining the Ethics Commitee approval, ASA I-II class, 40 patients undergoing elective surgery included to the study. Following Esmarch bandage and inflating of proximal tourniquet 100 mmHg over the systolic arterial pressure, cases divided into lidocaine 4 mg kg-1 (Group A, n=20) and lidocaine 4 mg kg-1 + clonidine 0.5 ?g kg-1 (Group B, n=20) groups. Ten minutes after the injection, proximal tourniquet deflated and distal tourniquet inflated. Preoperative basal measurements and heart rate and blood pressures were recorded 5 times with 2 minutes intervals after tourniquet deflation. VAS scores and sedation scores were evaluated in the first and second hours. Patient's first analgesic taking time was recorded. No significant statistical differences were detected in level of analgesia during operation between groups. Mean heart rate did not changed between groups after tourniquet deflation. Blood pressure values in group B, both within group and between groups were lower (p<0.05). VAS averages were lower in first and second hours in group B (p<0.05). In group B, the first analgesic taking time was longer than group A (p<0.05). We concluded that during IVRA, adding clonidine to lidocaine increases the analgesia quality after tourniquet deflation and prolongs the first analgesic need of cases.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.
