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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 Anaphylactic shock in caesarean section(Turkish Anaesthesiology and Intensive Care Society, 2014) Şanli M.; Gülhaş N.; Akgül Erdil F.; Miniksar H.; Demiröz D.; Durmuş M.Following contact with the allergen, allergic reactions ranging from the urticaria to anaphylaxis can be seen. The incidence of anaphylactic reactions in patients with asthma and allergic rhinitis are in higher rates in general population. Perianaesthetic anaphylaxis are important. It may be severe and potentially associated with adverse outcomes unless urgently recognized and treated. Anaphylaxis has been reported in the literature, with commonly used substances like latex, antibiotics, ranitidine, colloid solutions. Development of anaphylactic shock due to use of oxytocin is a rare side effect. In this case report, we aimed to present the anesthetic management of anaphylactic shock in a pregnant women, without a history of allergic reaction, developed immediately after infusion of oxytocin during cesarean section.Öğe Antibacterial effectiveness of alkalinized ropivacaine and bupivacaine(2007) Begeç Z.; Gülhaş N.; Toprak H.I.; Erdil F.; Yetkin G.; Özean Ersoy M.Aim: We aimed to investigate the antibacterial effects of alkalinized ropivacaine and bupivacaine on the Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa Materials and Methods: In this study, solutions of bupivacaine 0.5%, ropivaeaine 0.2%, bupivakain 0.5%+NaHCO3, ropivakain 0.2%+NaHCO3 with bactorial cultures' E. coli, S. aureus and P. aeruginosa were used. Bacteria were grown on standard blood agar. Bacterial cultures were prepared in a density of 0.5 McFarlands units (10 8 efu ml-1) with sterile saline 0.9% and each bacterial solution was further diluted in Mueller-Hinton broth to obtain standard inocula (105 cfu ml-1). The tested solutions (2 ml) and controls (2 ml, physiological saline) were added to 2 ml of standard bacterial preparations. Aliquats (3 ml) were vortexed and pipetted into sterile polystyrene spectrophotometer cuvets and it was incubated at 37°C. The optical density at 540 nm was measured at 0, 3 and 6 h by spectrophotometer. Results: While hupivacaine inhibited the growth of S. aureus and E. coli at all measurements times, P. aeruginosa inhibited at only 6 h (p<0.05). Alkalinized bupivacaine inhibited the growth of S. aureus at 0 h and E. coli at 0 and 6 h (p<0.05). Antibacterial effects of hupivacaine on E. coli was significantly higher than alkalinized bupivacaine at 6h (p<0.05). While ropivaeaine more inhibited the growth of S. aureus at 0 and 3 h than alkalinized ropivauaine, alkalinized ropivacaine less inhibited it according to the control (p<0.05). While both ropivacainc and alkalinized ropivakain inhibited the growth of E. coli at 3 and 6 h, at 0 h only ropivacaine inhibited it (p<0.05). Ropivacaine and alkalinized ropivaeaine inhibited the growth of P. aeruginosa at 3 h (p<0.05). Conclusion: It has been determined that bupivacaine has antibacterial effect and alkalinization of bupivacaine does not change it, ropivacaine has poor antibacterial effect and it more reduced with alkalinization of ropivacaine.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 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 The comparison of hemodynamic effects of remifentanil or fentanyl addition to midazolam infusion for total intravenous anesthesia in coronary artery bypass surgery(2004) Köro?lu A.; Gedik E.; Gülhaş N.; Toprak H.I.; Karaaslan K.; Özcan Ersoy M.We aimed to determine the effects of remifentanil or fentanyl infusion with midazolam on response to endotracheal intubation, surgical stimulus and intraoperative hemodynamics in coronary artery bypass surgery. Anesthesia was induced with thiopental sodium 0.5-3 mg kg-1 and 2 ?g kg-1 remifentanil (Group R, n=31), or 15 ?g kg-1 fentanyl (Group F, n=29) in 60 cases included into the study. Anesthesia was maintained with 1 ?g kg-1 min-1 remifentanil in group R or 0.15 ?g kg-1 min-1 fentanyl in group F in addition to the midazolam infusion 0.15 mg kg-1 h-1. Mean arterial pressure (MAP), heart rate (HR) were recorded at 1, 3 and 5 min after intubation and surgical stimulus and 5 min intervals during surgery. Also time to intubation and complications were recorded. Heart rate was lower in group R after anesthesia induction. During opioid infusion both MAP and HR decreased more in group R than F. After skin incision, sternotomy and internal mamarian artery dissection MAP and HR were higher in group F than R. Hypertensive response to sternotomy, skin incision, internal mamarian artery dissection was less in group R than group F. Frequency of hypertension and requirement of nitroglycerin were lower in group R than group F during CPB. We concluded that thiopental sodium with remifentanil or fentanyl in anesthesia induction did not prevent the hypertensive response to intubation. However maintenance with remifentanil and midazolam infusion was more effective in preventing surgical stimuli.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 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 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 fetal sex on local anaesthetic requirement in cesarean sections(2005) Gülhaş N.; Demirbilek S.; Öztürk E.; But A.K.; Do?an Z.; Ersoy M.Ö.Aim: Anaesthetic needs are different between female and male adults. The effect of fetal sex on maternal local anaesthetic requirements has not been examined in detail. The aim of this study was to assess if fetal sex was associated with maternal regional anaesthetic requirements in elective cesarean sections. Material and Methods: After obtaining hospital Ethics Committee approval, 46 elective cesarean sections in ASA class I and II patients were reviewed. After a pre-load of 10 mL kg-1 Ringer Lactate, combined spinal epidural anaesthesia was administered. Spinal block was performed with 7.5 mg hyperbaric bupivacaine. If the sensory block didn't reach the T 4 dermotome 5 mL of 7.5% ropivacaine was administered through the epidural catheter. Time to reach T4 sensory block and required local anaesthetic doses were recorded. Results: Sensory block levels of mothers with female fetuses were statistically higher at 5 min after subarachnoid injection (p<0.05). Additionally time to reach T4 was shorter and required less ropivacaine in the group with female fetuses (p<0.05). Conclusion: The results of this trial, suggest that mothers with female fetuses have reduced regional anesthetic requirements for Cesarian section. Further studies are warrated.Öğe The effects of solutions of hypertonic saline, hydraxyethyl starch and ringer lactate on hypotension before spinal or combined spinal epidural anesthesia in cesarean sections(AVES İbrahim KARA, 2007) Gülhaş N.; Kadir But A.; Köro?lu A.; Yapici E.; Erdil F.; Özean Ersoy M.Aim: We aimed to compare the effectiveness of different hydration fluids on prevention of maternal hypotension during spinal or combined spinal cpidural anaesthesia (CSEA). Materials and Methods: Sixty nine patients undergoing elective caesarcan section were included in the study. 3% Hypertonie saline solution (4 ml kg-1), 6% hydroxyethyl starch HES (5 mL kg -1) and lactated Ringer's solution (15 mL kg-1) were administered to Group HS (n=23), Group HES (n=23) and Group LR (n=23), respectively. The patients were performed CSEA with 0.5% hyperbaric bupivacainc 2.2 mL. For electrolyte measurements, serum samples were obtained before preloading the solutions and after CSEA, and from the umbilical cord after delivery. Results: There were no significant differences among the groups in the incidence of hypotension (in groups HS, HES, and LR, % 56, % 47, % 60, respectively) and the amount of ephedrine consumption. Maternal sodium, chloride and osmolarity values after preloading were higher in Group HS than in Group HES (p<0.05). Maternal glucose value after preloading was higher in Group LR than in Group HS and HES (p<0.05). Maternal potassium values were similar among groups. Sodium and nsmnlarity values of the umbilical cord were higher in Group HS than in Group HES and LR (p<0.05). The values of umbilical venous1 pH were similar among groups. Conclusion: Although the incidence of maternal hypotension and the amount of ephedrinc consumption were not different among the loading solutions, we hold the opinion that due to hypertonic saline may allow smaller preloading volume it may be an alternative.Öğe The Effects of The Alfentanil and Remifentanil on Haemodynamic Variables and Postoperative Recovery at Gynaecologic Laparoscopy(2003) Toprak H.I.; Köro?lu A.; Gülhaş N.; To?al T.; Gedik E.; Aslan Ü.; Ersoy M.Ö.Anaesthetic and surgical developments increase the interest to outpatient surgery. Remifentanil, a short acting opioid, is a good alternative to alfentanil for outpatient surgery. We aimed to compare the effects of the alfentanil and remifentanil on haemodynamic variables, postoperative recovery and complication incidence during desflurane used at gynaecologic laparoscopic procedures. Fourty-two patients were included to the study after approval by local ethic committee. After anaesthesia induction was performed by 2 mg kg -1 propofol and 0.1 mg kg-1 vecuronium, the patients were randomly allocated into two groups. In alfentanil group (group A), alfentanil was received 15 ?g kg-1 bolus followed by 1 ?g kg dk -1 until incision and then continued 0.5 ?g kg dk-1. In remifentanil group (group R), remifentanil was received 1 ?g kg -1 bolus followed by 0.5 ?g kg dk-1 until incision and then continued 0.25 ?g kg dk-1. Anaesthesia was maintained with desflurane 3-5 % volume with 40 % oxygen in air. Mechanical ventilation was adjusted to achieve ETCO2 pressure of 35-40 mmHg. Mean arterial pressure (MAP), heart rate (HR) and SpO2 were recorded 10 min intervals during operation and 15 min intervals for postoperative 90 min period. End of the operation, the times of spontaneous ventilation, eye opening, extubation and orientation, and visual analogue scores (VAS), time for Aldrete score >8, first analgesic used and vomiting-nausea were recorded. There were no significant differences in recovery profiles and complications between two groups. All MAP values and HR at the time of 10th, 20th, 30th min, before and after extubation were significantly higher in group A than the other group. In group A, although MAP values were significantly higher at 40th min, before and after extubation, HR values were significantly lower at 20th, 30th, 40th and 50th min compared with baseline values. In group R, MAP values except 40th min and after extubation were lower compared with baseline values. HR values except after extubation were lower compared with baseline value. VAS was lower significantly at postoperative 15th min in group R. In conclusion, remifentanil is a better choice in gynaecologic laparoscopic procedures for haemodynamic stability in balanced anaesthesia than alfentanil. When remifentanil used, postoperative analgesia should be performed before the end of the operation.Öğe The efficacy of remifentanil combined with either propofol, sevoflurane or desflurane during controlled hypotension(2004) Demirbilek S.; Gülhaş N.; Öztürk E.; But A.K.; Aslan Ü.; Ersoy M.Ö.The aim of this study was to compare the effects of a combination of remifentanil with propofol, desflurane or sevoflurane on intraoperative controlled hypotension, quality of the surgical field and recovery characteristics in patients undergoing nose surgery. ASA physical status I, 18-47 yr of age, 54 patients were randomly divided to three groups and received remifentanil 1?g kg-1 as a bolus dose followed by a continuous infusion of 0.25 ?g kg-1 min-1. In propofol group, anesthesia was induced 1.5-2 mg kg-1 of propofol and maintained with a continuous infusion of 100-200 ?g kg-1 min-1. In sevoflurane group, anesthesia was induced with 7% sevoflurane in 100% oxygen, and was maintained with 1-2% sevoflurane and air in oxygen. In desflurane group, anesthesia was induced 1.5-2 mg kg-1 of propofol and maintained with 4-6% desflurane and air in oxygen. The study drug titration was adjusted to keep the systolic blood pressure (SBP) between 80-100 mmHg during surgery. During controlled hypotension, while SBP was significantly lower in desflurane and sevoflurane groups than in propofol group, mean blood pressure (MBP) was significantly lower in sevoflurane group than in other groups (p<0.05). Supplemental hypotensive agent was administered to 2 patients in propofol group and 1 patient in desflurane group. After extubation, MBP and heart rate (HR) significantly increased in propofol group, HR significantly increased in sevoflurane group, SBP, MBP and HR significantly increased in desflurane group according to preinduction values (p<0.05). Estimated blood loss and surgical field score was similar in all three groups. The time to extubation and early recovery was significantly shorter in desflurane group than in sevoflurane and propofol groups (p<0.05). We concluded that since all three anesthetic techniques provided hemodynamic stability and good visualization of the surgical field, they may be used for controlled hypotension management. However, sevoflurane-remifentanil combination may be preferable, because it did not cause any increase in blood pressure after extubation.Öğe Factors determining the duration of tracheal intubation in patients undergoing coronary artery bypass surgery: Perioperative risk analysis(2006) Akgül Erdil F.; But A.K.; Gülhaş N.; Begeç Z.; Nisani?lu V.; Battalo?lu B.; Ersoy M.Ö.Aim of our retrospective study was to identify perioperative risk factors of extubation times after coronary artery bypass greffing (CABG). One thousand one hundred and seventy one patients undergoing CABG in our hospital between September 2001 and December 2005 were included in this study. These patients were divided into 2 groups depending on whether mechanical ventilation time was shorter than 6 hours (Group I; n=332), or longer than 6 hours (Group II; n=849). Demographic, intraoperative and postoperative patient characteristics were compared, and multivariate logistic regression analysis was used to ideatify risk factors effecting extubation time after CABG. Multivariate logistic regression analysis of demographic variables identified, age, previous MI, hypertension, COPD, unstable angina and carotid artery disease as risk factors of extubation time after CABG. Multivariate logistic regression analysis of perioperative variables identified, mean number of distal anastomoses, mean cross-clamp time, inotropic support and incidence of postoperative atrial fibrillation as risk factors for extubation time after CABG. Mean intensive care unit and hospital stays of late extubated group were found as statistically longer than that of early extubated group. In this retrospective study; it was found that preoperative variables had more important effects on late extubation than that of perioperative variables. We concluded that by improving preoperative care quality and preventing perioperative limiting factors of early extubation, more patients would benefit from early extubation. In this manner, morbidity of CABG would be decreased.Öğe Hemodynamic effects of bupivacaine and ropivacaine in cesarean section(AVES İbrahim KARA, 2006) Öztürk E.; But A.; Gülhaş N.; Begeç Z.; Do?an Z.; Yapici E.; Ersoy M.Ö.Aim: Local anesthetics for spinal aneaesthesia, provides a comfortable anaesthesia with their sensorial and motor block effect. However symphatic block causes hypotension in patients and this hypotension may cause nausea, vomiting and decrease in uterine blood flow, The purpose of this study is to compare the hemodynamic effects of equivalent doses of each ropivacainc and bupivaciane given intratecally in combination with fentanyl for elective cesarean section. Materials and Methods: Tthirty-six ASA I-II patients undergoing elective cesarean section were enrolled the study. After administration of 15 mL kg ringers lactate on sitting position combined spinal-epidural anesthesia performed. Patients randomly allocated in group B (n=18) (bupivacaine heavy 11 mg) and group R (n=18) (ropivacaine heavy 11 mg) and 25 ?g Fentanyl added to local anesthetics. Systolic arterial pressure (SAP), heart rate (HR) and sensorial block levels were recorded during the operation. Ephedrine infusion was used to obtaining a stable hemodynamia during the operation. Results: Total ephedrine infusion and total ephedrine consumption was greater in group R than in group B (p<0.01). SAP values at 2, 4, 6, 8, 10 min in Group B were significantly lower than baseline value (p<0.05). HR values at 2, 4, 6, 8, min in Group R were significantly higher compared to the baseline value (p<0.05). HR values were significantly higher than baseline value at all times except HR 20 in group B. Mean sensorial block level was (T6) in Group R and (T4) in Group B (p=0.001). Additional local anesthetic was administered the 8 patients in only group R through epidural catheter (p=0,001). No patients in group B needed to additional local anesthetics Conclusion: Lower sensorial block levels were obtained with ropivacaine when compared to the similar doses of bupivacaine. It was concluded that bupivacaine is more potent than ropivacaine in spite of opioid addition.Öğe Identifying malnutrition with subjective global assessment in hospitalized elective surgical patients(2007) Çiçek M.; Gedik E.; Gülhaş N.; Do?an Z.; Ersoy M.Ö.Aim: Malnourished patients have longer hospitalization time, increased drug usage, less functional capacity and higher morbidity and mortality rates compared to well-nourished patients. It has been reported that American Society of Anesthesiologists physical status (ASA) evaluation is not suitable in 'estimating nutritional status and this should be evaluated seperately. In this study, the aim was to determine nutritional status of adult hospitalized elective surgical patients with Subjective Global Assessment during preanesthetic evaluation. In addition, patients' age and hospitalization time was evaluated before preanesthetic evaluation with regard to their nutritional status. Material and Method: A total of 450 adult patients from 9 departments were included in this study. Following preanesthetic evaluation, patients' nutritional evaluation were performed in accordance with Subjective Global Assessment. Results: Overall prevalence of malnutrition in adult hospitalized elective surgical patients was determined as 24.22 %. Highest risk of malnutrition was determined in cardiovascular (50.00 %), orthopedic (36.17 %) and general surgery (31.70 %) patients. Mean age and hospitalization time were significantly higher in malnourished patients when compared to well-nourished patients as determined in the preanesthesic evaluation (p<0.05). Conclusion: Overall prevalence of malnutrition in adult elective surgical patients was 24.22 %. The departments with highest rates of patients with malnutrition were Cardiovascular Surgery, Orthopedic Surgery and General Surgery. In addition, it was concluded that malnourished patients tended to have higher mean age and a longer mean hospitalization time before preanesthesic evaluation.Öğe Simultaneous use of continuous veno-venous hemodiafiltration and activated protein C for treatment of septic shock and acute renal failure (case report)(2006) Çiçek M.; Gedik E.; Do?an Z.; Gülhaş N.; Ersoy M.Ö.Objective: The mortality of severe sepsis and septic shock is extremely high. We aimed to present a case to which we applicated continuous veno-venous hemodiafiltration and activated protein C for treatment of septic shock and acute renal failure. Case report: Assessment of the 42 -year old male with gun-shot wound in the emergency service revealed that Glasgow Coma Scale 3, isochoric pupils, bilateral positive light reflex, cold and pale skin, spontaneous ventilation rate (38 min-1), blood pressure (64/42 mmHg), and heart rate (174 min-1). In urgent operation, primary repair of liver laceration and diaphragm rupture, cholecystectomy, caecum resection and ileocolostomy, greft to femoral artery, thorax drainage with bilateral tubes, orchiectomy and debridment of tibia fracture were performed. After the operation, he was mechanically ventilated in intensive care unit. In first day, APACHE II score was determined as 34. In the 9th day, septic shock and acute renal failure developed in spite of antibacterial and supportive treatments. In another operation, subhepatic abscess drainage, repair of ileocolic anastomosis and ileostomy were performed. Activated protein C and continuous veno-venous hemodiafiltration were started following the operation. Activated protein C treatment was stopped for 2 hours and than percutaneous tracheotomy was performed. Activated protein C was started again one hour after the tracheotomy and than administered totally 96 hours. Patient was discharged with tibia fracture sequel in the 47th day. Conclusion: In a case with septic shock and acute renal failure due to abdominal infection, in addition to standard care and treatment of cause of sepsis, simultaneous continuous veno-venous hemodiafiltration application and activated protein C administration may be life-saving.
