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Öğe Anaesthetic management of a phaeochromocytoma patient with aortic valve insufficiency(2002) But A.K.; Durmuş M.; Gedik E.; Karaaslan K.; Toprak H.I.; Ersoy M.O.Phaeochromocytoma is an uncommon neuroectodermic tumour of adrenal medulla. Additional cardiac problems make anaesthesia management of phaeochromocytoma more complicated. We aimed to present the anaesthetic management of phaeochromocytoma patient with aortic valve insufficiency (AVI). A 45 years-old, 65 kg, female patient with third degree of AVI was admitted for phaeochromocytoma surgery. Before surgery, she was pre-treated with phenoxybenzamine and nicardipine for a week. In the operation room, thoracic epidural analgesia was maintained with 10 mL 0.5% bupivacaine loading dose, followed by 5 mL 0.5% bapivacaine for every hour during surgery. Then anaesthesia was induced with midazolam, droperidol, fentanyl, vecuronium, metoprolol and lidocaine. High dose fentanyl anaesthesia with 0.5-1.5% isoflurane were preferred for maintenance of anaesthesia. Haemodynamic stability was obtained with this anaesthesia management with lower dose vasodilators until the resection of adrenal mass. After the resection, severe hypotension was controlled with inotropic agents. Surgery was completed uneventfully and patient was transferred to ICU. In phaeochromocytoma cases with AVI, we think that appropriate anaesthetic approach is the thoracal epidural analgesia and high dose fentanyl anaesthesia with support of vasodilatators or vasoactive agents.Öğe Anesthetic management of a patient with sirenomelia: A case report(AVES, 2012) Yücel A.; Begeç Z.; Erdo?an M.A.; Konur H.; Ergin H.; Ersoy M.O.Sirenomelia or mermaid syndrome is an extremely rare developmental malformation characterized by complete or partial hipotrophy or fusion of the lower limbs. Gastrointestinal and urogenital anomalies are often accompanies with this congenital syndrome. Difficulty in determining the location of the peripheral veins and abnormal venous drainage may limit the use of limb for intravenous access. Associated anomalies should be identified and measures should be taken during the preoperative period. In this report we discussed anesthetic management of a patient diagnosed as sirenomelia syndrome.Öğe Anesthetic management of a patients with acute type A aortic dissection immediately after caesarean section(2012) Yücel A.; Gedik E.; Özgül Ü.; Erdo?an Kayhan G.; Koç E.; Erdil N.; Ersoy M.O.Acute aortic dissection is a disease which characterized by arterial wall separation, intimal dissection and hematoma. It has been seen half of dissections in women less than 40 yr of age occur during pregnancy, more commonly in the third trimester and postpartum period. Aortic dissection is a potentially risk factor for mother and baby during pregnancy. Ehlers-Danlos and Marfan's syndrome and number of pregnancy are associated with occurring of the aortic dissection. In this report, we discuss the management of anesthesia a patient with Marfanoid appearance who developed type A dissection of the aorta occurred 4 hours after elective Caeserean section.Öğe Comparison of analgesic effects of intravenous dexketoprofen trometamol, lornoxicam and paracetamol on postoperative pain after total abdominal hysterectomy(AVES, 2011) Gülhaş N.; Durmuş M.; Yücel A.; Şahin T.; Erdil F.A.; Yolo?lu S.; Ersoy M.O.Objective: This study was intended to evaluate the analgesic efficacy of intravenously administered dexketoprofen trometamol in comparison with lornoxicam and paracetamol for acute postoperative pain. Material and Methods: 120 ASA physical status I-II patients undergoing total abdominal hysterectomy were enrolled in this study and randomly allocated into four groups (Groups D, L, P, and C). Following standard monitorization, in all groups, induction of anaesthesia was achieved via intravenous route using 5-7 mg kg-1 thiopental, 1 ?g kg-1 fentanyl, and 0.1 mg kg-1 vecuronium bromide, and also 6-8 % concentration of desflurane in 50 % O2 50 % N2O was used for the maintenance of anaesthesia in all groups. Patients received intravenous dexketoprofen trometamol 50 mg (Group D), 8 mg lornoxicam (Group L), 1 g paracetamol (Group P) and 100 mL SF (Group C) 30 min before the end of the surgery and 8-16 h after the surgery in Groups D, L, C. Group P received rescue medication at 6., 12., 18. and 24h after the surgery. At the end of the surgery, all patients received fentanyl via a patient controlled iv analgesia (PCA) device. Pain scores, cumulative fentanyl consumption, and patient satisfaction scores were assessed at 30 min, 2., 4., 6., 12. and 24h postoperatively. Results: The VAS scores at all evaluation time points, were similar among the groups. Fentanly consumption at 6., 12. and 24h postoperatively in Group P, L, and D was significantly lower when compared with Group C (p<0,05). Fentanyl consumption in Group L was lower relative to the other groups without any statistical significance. The patients' satisfaction scores at 6., 12. and 24h postoperatively in Group L were higher than the other groups (p<0,05). There was no significant difference between groups regarding sedation scores and side effects observed like postoperative nausea and vomiting and indigestion. Conclusion: We concluded that iv paracetamol, lornoxicam and dexketoprofen trometamol were equivalent in terms of analgesic efficiency in the management of postoperative pain after total abdominal hysterectomy.Öğe Comparison of cardiovascular effects and intubating conditions of cisatracurium and rocuronium in patients with coronary artery disease(2000) Torkoz A.; But A.K.; Koroglu A.; Durmus M.; Togal T.; Ersoy M.O.This study was designed to compare the cardiovascular effects and intubation condition of cisatracurium and rocuronium in cardiac surgical patients. Twenty patients scheduled for elective coronary artery bypass surgery were randomly assigned into two equal groups in a double blind fashion. Patients in group R (n=10) were given 0.9 mg/kg rocuronium and patients in group C (n=10) were given 0.15 mg/kg cisatracurium. Tracheal intubation was performed upon completion of maximum depression (% 100) in Train-of-four stimulation. Intubation conditions were rated according to Goldberg scale [1 (excellent) to 4 (intubation not possible)]. Heart rate (HR), systolic and diastolic arterial pressure SAP and DAP), central venous pressure (CVP), mean pulmonary artery pressure (PAPm), pulmonary artery wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), systemic and pulmonary vascular resistances (SVR and PVR) were measured invasively. Measurements were made before induction, 2 min after induction of anesthesia (basal), 1 min after after administration of muscle relaxant, at maximum depression in TOF and 2, 5, 10 min after intubation. Intubation condition were excellent in 60% of patients in the rocuronium group and in 90% of patients in the cisatracurium group, however there were no significant differences between the two groups (p>0.05). Rocuronium produced statistically significant increase in the heart rate at maximum depression in TOF, 2 min after intubation and in systolic blood pressure at 2 min after intubation (p<0.05). Other hemodynamic changes (DBP, CVP, CO, CI, PAPm, PAWP, SVR, PVR) were similar in the groups. As a result, induction with cisatracurium presented a more haemodynamically stable situation than rocuronium, but increases of cardiac rate and blood pressure with rocuronium were within clinically acceptable values.Öğe Comparison of haemodynamic profile and recovery characteristics of total intravenous anaesthesia and desflurane anaesthesia in paediatric outpatient surgery(2005) Özpolat Z.; To?al T.; Toprak H.I.; Öztürk E.; Çiçek M.; Ülger H.; Ersoy M.O.Aim: We aimed to compare the intraoperative haemodynamic profile and recovery characteristics of total intravenous anaesthesia (TIVA) with remifentanilpropofol and inhalation anaesthesia with desflurane-N2O in paediatric patients. Materials and Methods: Fifty children, ASA I, aged 4-12 years undergoing tonsillectomy, adenoidectomy or insertion of ventilation tubes, were included into the study. After premedication with midazolam orally, induction was performed intravenously with lidoeaine 1 mg kg-1, remifentanil 1 ?g kg-1, propofol 3 mg kg-1 and vecuronium 0.1 mg kg-1. Patients were divided into two groups: In Group I, remifentanil 0.5 ?g kg-1 min-1 and propofol 50 ug kg-1 min-1 were given; in Group II, desflurane 8.3 % and N2O 50 % in O2 were given. The heart rate (HR), mean arterial pressure (MAP), SpO2, PETCO2 and body temperature were monitorized. Emergence and recovery times, side effects like hypoxia, laryngospasm, nausea-vomiting, pain, and agitation were recorded. Results: In Group I, MAP increased at all times except after induction when compared with baseline, and decreased at all times except after intubation and surgical incision in Group II. HR decreased at surgical incision, 10, 20 and 30 minutes after incision in Group I when compared with baseline, and at all times except after intubation and surgical incision in Group II (p<0.05). In Group II, MAP was lower and HR was higher when compared with Group I. Eve-opening time and time to reach Aldrete score >8 in Group II was longer than in Group I. The time of spontaneous ventilation and extubation, and side effects were similar between groups. The incidence of postoperative pain and agitation was high in both groups. Conclusion: We concluded that both TIVA with propofol-remifentanil and desflurane-N2O based anaesthesia are suitable methods with short postoperative recovery for outpatient paediatric cases. However haemodynamic instability, postoperative agitation and pain are serious problems with both methods that should be solved.Öğe Comparison of the Effects of Ketamine and Propofol Combined with Remifentanil 1 ?g kg-1 Bolus on Hemodynamic Changes and Intubating Conditions during Anesthetic Induction(2003) Demirbilek S.; To?al T.; Gülhaş N.; Çiçek M.; Do?an Z.; Ersoy M.O.Aim of this study was to compare the effects of ketamine and propofol combined with remifentanil 1 ?g kg-1 bolus on hemodynamic changes and intubating conditions during anesthetic induction. After obtaining approval from the Ethics Committee and patient informed consent, 44 patients, ASA physical status I, aged 20-56 years, who scheduled for elective surgery, were divided into two groups randomly. After administration of a bolus dose of remifentanil 1 ?g kg-1, patients in group K (n=22) received ketamine 1-1.5 mg kg-1, group P (n=22) received propofol 1.5-2 mg kg-1. The trachea was intubated 3 minutes after administration of vecuronium 0.1 mg kg-1 in all patients. The quality of intubation was scored as perfect, good and poor. Anesthesia was maintained with sevoflurane 1-1.5 % and 50 % nitrous oxide in oxygen, and if necessary remifentanil 0.5 pg kg-1 was administered. Systolic blood pressure (SAP), diastolic blood pressure (DAP), mean arterial pressure (MAP) and heart rate (HR) were recorded before (control) and after induction, before and 1, 3 and 5 min after placement of the tracheal tube, 1 min after surgical incision and every 5 min up to 30 minutes. Until surgical incision, SAP, DAP, MAP and HR were higher in group K than group P. There were no significance between groups regarding intubation scores and additional remifentanil requirements. As a result, we concluded that 1 pg kg-1 bolus of remifentanil combined with ketamine during induction provides better hemodynamic stability, and similar intubating conditions, when comparing those of propofol-remifentanil induction.Öğe Comparison of the Fresh Gas Flows Adjusted to the Body Weights in Patients Undergoing Low Flow Anaesthesia Either with Isoflurane or Desflurane(2004) To?al T.; Ayas A.; Demirbilek S.; Gedik E.; Köro?lu A.; Karaaslan K.; Ersoy M.O.In this study, we aimed to examine the effects of fresh gas flow (FGF) adjusted to the body weight (10-20-30 mL kg-1 min-1) in patients undergoing low flow anesthesia either with isoflurane or desflurane on hemodynamics, body temperature, concentration of oxygen and anesthetic gases. Sixty ASA I-II adult patients undergoing elective surgical procedures were included into the study. Patients were randomly allocated into two basic groups to receive either isoflurane or desflurane. Then these basic groups were randomly divided into 3 sub-groups to receive 10, 20 or 30 mL k-1 min-1 FGF. After standard anesthetic induction and intubation, during the first 10 minutes, FGF was 4 L min-1 with isoflurane 1.5 % or desflurane 6 % in 50% oxygen and 50 % nitrous oxide. Then concentrations of isoflurane and desflurane were set as 2 % and 8 % respectively and FGF was adjusted according to the groups. Heart rate (HR), mean arterial pressure (MAP), SpO2, esophageal temperature, vaporizer settings, inspired and expired anesthetic concentrations were recorded at regular intervals throughout the study. Inspired and expired anesthetic concentrations were found to be decreased significantly in the 10 mL kg-1 min-1 flow groups when compared to the 20 and 30 mL kg-1 min-1 flow groups (p<0.05). The inspired oxygen concentration (FiO2) decreased parallel to the duration of anesthesia. Low FiO2 was observed in 2 cases in isoflurane group with 10 mL kg-1 min -1 flow and in 8 cases in desflurane group with 10 mL kg -1 min-1 flow (p<0.05). We concluded that, isoflurane and desflurane could be used safely with FGF of 10 and 20 mL kg-1 min-1 providing hemodynamic stability. However, there is was a risk of hypoxia in desflurane group with FGF of 10 mL kg-1 min -1. But, this can be prevented by increasing FiO2.Öğe Conduta anestésica em criança com osteogênese imperfeita e hemorragia epidural(Elsevier Editora Ltda, 2013) Erdogan M.A.; Sanli M.; Ersoy M.O.[No abstract available]Öğe Does single dose premedication of dexmedetomidine reduce pain during injection of propofol?(2007) Erdil F.A.; Gulhas N.; But A.K.; Begec Z.; Ersoy M.O.Background and objective: Pain on injection is still a major problem with propofol. In this study, we compared the efficacy of single-dose premedication of dexmedetomidine for pain on injection of propofol and its effect on the incidence and the severity of the pain after propofol injection. Methods: We conducted a prospective, randomized and double-blind study of 100 patients scheduled to undergo surgery. Patients were randomly assigned to one of two groups, either receiving dexmedetomidine (Group D) or saline (Group C) before the injection of propofol. Patients in Group D (n = 50) were given dexmedetomidine infusion 0.6 ?g/kg for 10 min. Patients in Group C (n = 50) were given saline infusion in an identical manner. Pain perception was assessed during injection of propofol in all patients. Results: The median pain score on injection of propofol was significantly lower in Group D than in Group C (median pain score 2 [1-3] vs 1 [0-2]; P < 0.006). The number of patients with pain in Group D decreased (48/50 [96%] in Group C vs 42/50 [84%] in Group D; P = 0.046). Conclusions: Intravenous administration of a single dose of dexmedetomidine as a premedication reduced the incidence and severity of pain on propofol injection without significant adverse haemodynamic effects. © 2007 W.S. Maney & Son Ltd.Öğe Does the supplementation of fentanyl to bupivacaine affect unilateral spinal block?(2001) Durmuş M.; Türköz A.; To?al T.; Ayas A.; Öztürk E.; Ersoy M.O.The purpose of this study was to evaluate the affects of supplementation of fentanyl to rapid administered low dose hyperbaric bupivacaine for unilateral spinal anaesthesia in arthroscopic surgery. Thirty patients undergoing arthroscopic surgery were placed in the lateral position. After dural puncture (25-gauge Whitacre spinal needle), the needle hole was turned toward the dependent side and patients were randomly assigned to receive 7.5 mg of 0.5 % hyperbaric bupivacaine (Group I, n=15) or 7.5 mg of 0.5 % hiperbaric bupivacaine + 25 ?g fentanyl (Group II, n=15). Lateral and horizontal positions were maintained for 15 min before the patients were turned to supine position. Sensory block levels were assessed with three minutes intervals during lateral position and 5 minutes intervals during supine position and motor block levels were assessed with 15 minutes intervals. Spinal anaesthesia was unilateral in 80 % of group I and 13 % of group II at the end of the 15 min; after 60 min, spinal anaesthesia was unilateral in 80 % of group I and 0 % of group II (p<0.005). We conclude that fentanyl supplementation to low dose hyperbaric bupivacaine was disadvantageous in obtaining unilateral spinal anaesthesia although we can obtain long-term sensory block.Öğe Efeitos antimicrobianos de cetamina em combinação com propofol: Um estudo in vitro(Elsevier Editora Ltda, 2013) Begec Z.; Yucel A.; Yakupogullari Y.; Erdogan M.A.; Duman Y.; Durmus M.; Ersoy M.O.[No abstract available]Öğe The effects of intra-operative low-dose dexmedetomidine infusion on postoperative pain in patients undergoing septorhinoplasty(Maney Publishing, 2006) Cicek M.; Yucel A.; Gedik E.; Sagir O.; But A.K.; Ersoy M.O.Study objective: To determine the effects of intra-operative low-dose dexmedetomidine infusion on postoperative morphine consumption, pain, sedation and patient satisfaction in patients undergoing septorhinoplasty. Method: Fifty adult patients were randomised to receive either dexmedetomidine (a loading dose of 1 ?g kg-1 for the first ten minutes and a maintenance dose of 0.2 ?g kg-1 h-1 afterwards, Group D) or 0.9% saline in the same manner (Group C) after induction of anaesthesia. At the end of the operation, the infusions were discontinued. After extubation, patient controlled analgesia was started intravenously. Results: Patients in Group D consumed 47% less morphine than patients in Group C during the first 24 h and had a lower cumulative morphine consumption at all times after starting patient controlled analgesia (7.08 mg vs. 8.56 mg at 2 h (p < 0.05), 10.84 mg vs. 14.0 mg at 4 h (p < 0.05), 13.56 mg vs. 18.28 mg at 6 h (p < 0.05) and 17.96 mg vs. 33.72 mg at 24 h (p < 0.05), respectively in Group D and Group C). Visual analogue scale scores for pain were higher at all times in Group C than in Group D (p < 0.05). Sedation scores were higher in Group D than in Group C at 30 min after starting patient controlled analgesia (p < 0.05). Patient satisfaction scores were higher at all times in Group D than in Group C (p < 0.05). Conclusions: Intra-operative low-dose dexmedetomidine infusion during septorhinoplasty decreases postoperative morphine consumption, provides effective postoperative pain relief and achieves better patient satisfaction without increased adverse effects. © 2006 VSP.Öğe Effects of intrathecal fentanyl or meperidine addition to bupivacaine on hemodynamic variables, postoperative analgesic requirements, levels of histamine, IgE, basophiles and eosinophiles(2003) Köro?lu A.; Erdem S.; Çiçek M.; Do?an Z.; Sezgin N.; Ersoy M.O.The aim of our study is to compare the effects of intrathecal fentanyl and meperidine with bupivacaine on hemodynamics, postoperative analgesic requirement, side effects and levels of histamine, IgE, basophiles, eosinophiles and to investigate a possible relationship between itching and levels of basophiles and eosinophiles. Heart rate, mean arterial pressure, SpO2 values, respiration rates of 45 cases were recorded before and after spinal anesthesia. Intrathecal 10mg bupivacaine heavy was used in combination with 0.5 mL 0.9% NaCl in group B, 25 ?g fentanyl in group F, 25 mg meperidine in group M were given. Blood samples were collected to determine the plasma levels of histamine, IgE, basophiles and eosinophiles 30 min before spinal anaesthesia, and at the 8th, 60th minutes of spinal anaesthesia. Analgesic requirement was evaluated for postoperative 24 hours by using VAS. Although plasma levels of histamine and basophiles were significantly higher in group M and F at the 8th, 60th min of spinal anaesthesia, levels of histamine were significantly higher in group M than other two groups at the 8th min of spinal anaesthesia. VAS scores and analgesic requirements were significantly lower in group M than the other two groups at late postoperative period. Itching and vomiting incidences were higher in group F and there was no relationship between itching and levels of eosinophiles and basophiles. In conclusion, we determined that intrathecal fentanyl and meperidine did not effect hemodynamics, and meperidine provided better analgesia in the postoperative period. Although, histamine release increased with both opioids, it was more in meperidine than fentanyl, however fentanyl caused more vomiting and itching. There was no relationship between levels of eosinophiles, basophiles and itching.Öğe Effects of lntrathecal fentanyl in patients undergoing cesarean section(2000) Bakan N.; Ozpolat S.; Ayas A.; Ersoy M.O.In this study it is investigated the effects of fentanyl with intrathecal bupivacaine on 75 patients who underwent either elective or emergent cesarean sections. Patients were divided into three groups: Patients of Group I received 0.5 %, 2.5 mL bupivacaine; Group II received 0.5%, 2.5 mL bupivacaine+fentanyl 10 ?g and Group III received 0.5 %, 2.5 mL bupivacaine+fentanyl 15 ?g (per each group 25 patients), respectively. During procedure sistolic (SAP), diastolic (DAP) and mean (MAP) arterial pressures, heart rate, peripheral oxygen saturation, motor and sensorial block levels, analgesic efficacy (duration of efficient analgesia, total amount of analgesic) were monitored. Decrements in SAP and MAP at 3rd and 5th minutes were statistically significant between groups (p<0.05). First ephedrin administration time was shortest in 15 ?g fentanyl group (Group I: 11.60±5.59 min; Group II: 8.15±5.58 min; Group III: 5.11±4.31 min) which was statistically different between groups (p<0.05). Motor and sensory block levels were higher in fentanyl groups. Motor block level values at 1st and 5th min and sensory block levels at 1st, 15th and 30th min were statistically significant when compared within groups (p<0.05). Three patients in Group I required additional analgesia and in another patient surgery was completed with general anaesthesia. None of the patients in Group H and III required additional analgesia. Analgesic efficacy was similar in all groups. Effects on newborns as monitored with umblical blood gas analysis and APGAR scores were all similar and within normal limits. There was no significant difference between the groups regarding side effects, but intraoperative nausea was less in fentanyl groups. In conclusion; addition of fentanyl to intrathecal bupivacaine in each group of patients was found to fasten the establishment of profound block, as well as decreases the necessity of intraoperative additional analgesia and also decreaes nausea, which were all more prominent in 15 ?g fentanyl group.Öğe The effects of sevoflurane and propofol on hepatic and renal functions in elderly patients(2003) But A.K.; Durmuş M.; Köro?lu A.; Yücel A.; Ülger H.; Ersoy M.O.In this study, we aimed to compare the effects of sevoflurane and propofol on hepatic and renal functions in patients more than 65 years of age. 46 patients, ASA physical status I-II, more than 65 years of age, undergoing elective surgery were taken into the study. Anaesthesia was induced with 66% N2O and 7% sevoflurane in the group S (n=23) and iv.1-2 mg kg-1 propofol approximately within 30 seconds in the group P (n=23). Anesthesia was maintained with 1-4% sevoflurane and 66% N2O in group S, 2-10 m kg-1 hr1 propofol and 66% N2O in group P. Blood sample was taken from all patients preoperatively and postoperative 1, 3, 5-7 and 14.days to measure the total bilirubine (T.Bil.), aspartate aminotransferase (AST), g-glutamyl transferase (GGT), lactate dehydrogenase (LDH), alkalane phosphatase (ALP), creatinine (cre) and blood urea nitrogen (BUN). At the same time periods, creatinine clearences (K.Klr) were calculated, and protein and glucose qualitative analyses were done in urine. In Group S, AST and GGT at all postoperative periods, ALT and LDH in postoperatively 1 and 5-7th days, ALP and K.Klr in postoperatively 3rd day were measured significantly higher than preoperative basal values. In Group P, T.bil in postoperative 1st day, AST in postoperative 14th day, ALT and ALP at all postoperative periods, LDH in postoperative 1st and 3rd days were measured significantly higher than preoperative basal values. As a result; we concluded that sevoflurane and propofol anesthesia in ASA I-II elderly cases undergoing elective surgery, renal functions were preserved for both of the groups, but although there was no statistically significant difference between two groups, minimal transient hepatic dysfunctions were signifantly more in sevoflurane group.Öğe Emergent Anesthesia Management of a Premature Case with Asplenia Syndrome and Complex Congenital Heart Disease(2003) Çiçek M.; Köro?lu A.; To?al T.; Özpolat S.; Ersoy M.O.; Karada? N.A premature case with asplenia syndrome and complex congenital heart disease underwent an urgent laparotomy. After general anesthesia induction with fentanyl, atracurium and sevoflurane, single shot caudal anesthesia with bupivacaine was performed. There was no complication during the operation. The case was not extubated and transported to paediatric intensive care unit. He died at the postoperative fourth day because of heart failure and sepsis.Öğe Evaluation by train of four vecuronium induced neuromuscular block during sevoflurane and isoflurane anaesthesia(1999) Togal T.; Gedik E.; Ersoy M.O.Volatile anaesthetics enhance the action of neuromuscular blockade to various degrees, the purpose of the present study is to compare the effects of volatile anaesthetics (isoflurane and sevoflurane) on the onset time of the neuromuscular blockade by vecuronium. Following approval from the ethic committee, 20 ASA I-II patients of either sex, aged 17-61 years old, were scheduled for elective laparoscopic surgery. Patients were randomly allocated to two groups. While induction of anaesthesia was performed with thiopentone 6 mg/kg and vecuronium 0.07 mg/kg, fentanyl 1 ?g/kg, lidocaine 1 mg/kg and maintained by 66/33 % N2O/O2 and sevoflurane (1.7 %) group I and isoflurane (1.2 %) in group II. The EMG response of the adductor pollicis was monitored by TOF-Guard stimulator (Biometer) at 20s intervals after train of four (TOF) stimulation of the ulnar nerve. Following intubation, whenever T1 returned to 25 % control additional doses of vecuronium was given (0.02 mg/kg). Supramaximal stimuli, duration 0.2 miliseconds and frequency 2 Hz were delivered at 20 seconds intervals to the ulnar nerve. The onset time (T1 max), duration of block (T1 25 %), time to maximal block after the second dose (T2 max), duration of action of maintenance doses (T2 25 %) and recovery times (T2 75 % - 25 %) were the parameters measured. There were no statistical significant differences between two volatile anaesthetics effects. In conclusion the effects of sevoflurane are similar to those of isoflurane on the neuromuscular block produced by vecuronium.Öğe Glucose-insulin-potassium solution before cardiopulmonary bypass in coronary artery surgery(2000) Turkoz A.; Toprak H.I.; Sari S.; Ozturk E.; Durmus M.; Turkoz R.; Ersoy M.O.Glucose-insulin-potassium (GIK) solution has been advocated for the treatment of ischemic myocardium. This prospective, randomized clinical study was conducted to evaluate whether GIK solutions would cause benefit for the patients in addition to anterograd and retrograd combined blood cardioplegia undergoing coronary artery bypass grafting because of depressed left ventricle and unstable angina. The study group consisted of 33 patients with depressed left ventricle and unstable angina who underwent coronary artery bypass grafting, 2 patients were excluded from the study because of catheter dislocation. In 15 patients GIK solution (500 mL of 30 % dextrose, 70 units insuline, 80 mEq potassium) was given intravenously at 1 mL/kg per hour started with induction of anaesthesia, until the stage of cardiopulmonary bypass (CPB). Sixteen patients received ringer's lactate as the control group. The patients were analysed for hemodynamic changes, blood glucose and potassium levels. Pulmonary capillary wedge pressure, cardiac output, systemic vascular resistance, pulmonary vascular resistance were not different between two groups immediately before and after CPB. Blood glucose levels were not different between the two groups, but in both groups the levels increased after the end of the infusion of GIK solution, on the fifteenth minutes and at the end of the CPB. No differences were determined at the end of operation. There was no difference in serum potassium levels between the two groups, but potassium levels increased significantly during and immediately after CPB and decreased to the basal levels at the end of the operation in both groups. There was no significant difference between the groups in perioperative myocardial infarction, incidence of atrial and ventricular arrhythmias, times of ventilator support, length of stay in the intensive care unit and mortality. In this study, GIK therapy did not produce any additional positive hemodynamic effects and postoperative recovery from depressed left ventricle and urgent coronary artery bypass grafting.Öğe Hemodynamic, Hepatorenal and Postoperative Effects of Desflurane-Fentanyl and Midazolam-Fentanyl Anaesthesia in Coronary Artery Bypass Surgery(2004) But A.K.; Durmuş M.; Toprak H.I.; Öztürk E.; Demirbilek S.; Ersoy M.O.In this study, we aimed to compare the hemodynamic, hepatorenal and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anaesthesia during coronary artery bypass surgery. Sixty patients undergoing elective coronary artery bypass surgery with ejection fraction of more than 45% were included in the study. Patients were randomly divided into two groups as desflurane (Group D, n=30) and midazolam (Group M, n=30). Anaesthesia was induced with etomidate, 0.2 mg kg-1 and fentanyl, 5 ?g kg -1 in Group D and with midazolam, 0.1-0.3 mg kg-1 and fentanyl, 5 ?g kg-1 in Group M. For the maintenance of anaesthesia; desflurane, 2-6% and fentanyl, 15-25 ?g kg-1 were given in group D and infusion of midazolam at a rate of 0.1-0.5 mg kg -1 hr-1 and fentanyl at a rate of 15-25 ?g kg -1 were used in group M. Heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, left ventricle stroke work index and right ventricle stroke work index were measured before induction (t0), after induction (t1), after intubation (t2), after incision (t3), after sternotomy (t4), before cardiopulmonary bypass (t5), after protamine administration (t6) and at the end of the surgery (t7). Blood samples were taken to measure total bilirubine, aspartate amino transferase, gamma glutamyl transferase, lactate dehydrogenase, alkalane phosphatase, creatinine and blood urea nitrogen just before induction and at the 1st 4th and 14th days of postoperative period. In conclusion; intraoperative hemodynamic responses were similar in both of the groups and transient hepatic and renal dysfunction were observed in the postoperative period in both groups. The extubation and ICU discharge time were found to be shorter in the desflurane-fentanyl group.
