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Öğe Comparison of preoperative and postoperative approaches to ultrasound-guided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy(Scientific Publishers India, 2017) Dirican, B.; Erdogan, M.; Ucar, M.; Uzgul, U.; Gulhas, N.; Kayhan, G.; Durmus, M.Background: Transversus Abdominis Plane (TAP) block produces more effective postoperative analgesia and significantly reduces consumption of postoperative opioids after various abdominal surgeries. It can be performed either preoperatively or postoperatively. Furthermore studies investigating the ideal period for TAP block administration are few. The objective of our study was to investigate, which period is more effective for administration of TAP block on postoperative analgesia in patients undergoing total abdominal hysterectomy. Methods: This prospective randomized controlled double-blind study was conducted with 60 patients between the ages of 18-65 and ASA class I-II who were scheduled to undergo total abdominal hysterectomy. Patients who received a TAP block with ultrasound guidance prior to the surgical procedure were referred to as Group 1, the TAP block procedure after surgery made up Group 2. The rest and movement period Visual Analog Score (VAS), sedation score, nausea, vomiting and the need for additional analgesics were recorded at 2, 4, 6, 12 and 24 hours postoperatively. Results: When Group 1 was compared with Group 2, the rest period pain scores were significantly lower in Group 2 at 2 and 4 hours (p< 0.05). In Group 2, the 24-hour morphine consumption was significantly lower than that of Group 1 (p< 0.05). Conclusion: Post-operative administration of an US guided TAP block in total hysterectomy patients significantly decreased pain scores in early periods and also reduced 24 hour morphine consumption when compared with preoperative administration of the block.Öğe Density matters most Reply(Wiley-Blackwell Publishing, Inc, 2010) Erdil, F.; Bulut, S.; Demirbilek, S.; Gedik, E.; Gulhas, N.; Ersoy, M. O.[Abstract Not Available]Öğe The effects of ephedrine on maternal hypothermia in caesarean sections: a double blind randomized clinical trial(Verduci Publisher, 2013) Gulhas, N.; Tekdemir, D.; Durmus, M.; Yucel, A.; Erdil, F. A.; Yologlu, S.; Ersoy, M. O.BACKGROUND: The purpose of the study was to investigate the effect of bolus and the combination of bolus and infusion of ephedrine on maternal hypotermia which are used for treating maternal hypotension under spinal anaesthesia. PATIENTS AND METHODS: 110 ASA I-II patients who developed maternal hypotension were included into the study. Spinal anaesthesia was performed with 12.5 mg heavy bupivacaine + 15 mu g fentanyl. Group I: Ephedrine bolus 5 mg plus ephedrine infusion, Group B: Ephedrine bolus 5 mg plus normal saline infusion. The systolic blood pressure was allowed to range between 20% from baseline values. Ephedrine solution infusion started after hypotension occurred (0.5 mg/minute). The body temperature under 35.5 degrees C was accepted as hypothermia. The newborns' rectal temperature was measured. Moreover, the Apgar scores, umbilical vein-arterial blood gas and acid-base status were evaluated. RESULTS: In Group I, the body core temperatures which were measured at 9, 18, 33, and 39th minutes were significantly higher than Group B (p < 0.05). The prevalence of maternal hypothermia in Group I was significantly lower than the Group B, which were as 65.5% (36/55) and 85.5% (47/55), respectively (p < 0.05). In Group I, the newborn rectal temperatures and the total dose of ephedrine were significantly higher than Group B (p < 0.05). In Group I, the systolic and mean blood pressures were higher than Group B (p < 0.05). CONCLUSIONS: As a result, we found that combined bolus and infusion of ephedrine for treating maternal hypotension prevents maternal and neonatal hypothermia during caesarean section under spinal anaesthesia compared to bolus administrations alone.Öğe The effects of intrathecal levobupivacaine and bupivacaine in the elderly(Wiley-Blackwell Publishing, Inc, 2009) Erdil, F.; Bulut, S.; Demirbilek, S.; Gedik, E.; Gulhas, N.; Ersoy, M. O.P>The objective of this study was to compare the block durations and haemodynamic effects associated with intrathecal levobupivacaine or bupivacaine in elderly patients undergoing transurethral prostate surgery. Eighty patients were prospectively randomised to receive plain 1.5 ml levobupivacaine 0.5% (group levobupivacaine) or 1.5 ml plain bupivacaine 0.5% (group bupivacaine) in combination with fentanyl 0.3 ml (15 mu g) for spinal anaesthesia. The time to reach T10 and peak sensory block level, and to maximum motor block were significantly shorter in group bupivacaine compared to group levobupivacaine (p < 0.05). Peak sensory block level was also significantly higher in group bupivacaine. In group bupivacaine, mean arterial pressure was significantly lower than group levobupivacaine, starting from 10 min until 30 min after injection (p < 0.05). Hypotension and nausea were less common in group levobupivacaine than group bupivacaine (p < 0.05). Because of the better haemodynamic stability and fewer side-effects associated with levobupivacaine, it may be preferred for spinal anaesthesia in elderly patients.Öğe Remifentanil without muscle relaxants for intubation in microlaryngoscopy: a double blind randomised clinical trial(Verduci Publisher, 2013) Gulhas, N.; Topal, S.; Kayhan, G. Erdogan; Yucel, A.; Begec, Z.; Yologlu, S.; Durmus, M.OBJECTIVES: We aimed to compare the effect of remifentanil without muscle relaxant with succinylcholine for intubation in microlaryngoscopy. PATIENTS AND METHODS: Eighty patients were randomly divided into two groups: Group R (n=40) and S (n=40) received remifentanil 4 mu g/kg intravenously or 1 mu g/kg respectively. Anesthesia was induced with 2 mg/kg propofol in both groups. Intubation was performed after bolus administration of 10 ml saline as a placebo or 1 mg/kg of succinylcholine in Group R and S respectively. Remifentanil infusion was initiated at 0.025 mu g/kg in each groups. RESULTS: Intubation conditions were similar in both groups. The mean arterial pressure (MAP) values at post-induction period were significantly lower in the Group S than in the Group R (p = 0.001). The requirement for ephedrine in Group R was found to be significantly lower than Group S (p = 0.023). Recovery times were significantly shorter (p = 0.001) and recovery scores were significantly higher (p = 0.021) in Group R. Time to patient could respond to commands was significantly longer in the Group S (p = 0.001). The surgeon's satisfaction score was significantly higher in Group R (p = 0.001). CONCLUSIONS: It was concluded that remifentanil without muscle relaxants provides similar intubating conditions as that provided by succinylcholine, and remifentanil is superior to succinylcholine with regard to haemodynamic stability and recovery duration.Öğe Single intrathecal fentanyl for combined spinal epidural anesthesia confers no advantage over hemodynamic effects in elderly patients(Verduci Publisher, 2012) Yucel, A.; Gulhas, N.; Aydogan, M. S.; Erdogan, M. A.; Beytur, A.; Tasdemir, C.; Ersoy, M. O.Background: Neuroaxial blockade for ambulatory transurethral resection of the prostate is a well established technique. Patients in this group are often at high risk for perioperative complications from concurrent diseases. The purpose of this study was to compare the elderly patients who received intrathecal fentanyl alone or intrathecal fentanyl plus bupivacaine or epidural anesthesia for transurethral resection of prostate surgery. Material and Methods: Ninety-nine patients were prospectively randomized to receive fentanyl 25 mu g (Group F), fentanyl 25 mu g plus hyperbaric bupivacaine 2.5 mg (Group BF), or epidural anesthesia adding fentanyl 50 mu g (Group E) by combined spinal epidural anesthesia technique. Results: The amount of local anesthetics used until when the sensorial block reached the level of T10 was significantly lower in the Group BF than in the Group E and the Group F (p < 0.001). Maximum level of sensory block was significantly lower in the Group BF than in the Group E and the Group F (p = 0.01). The time elapsed until the sensory block reached T10, the regression of sensory block to L5 level were significantly lower in the Group BF than in the Group E and the Group F (p = 0.005, p < 0.001, respectively). Compared to the basal values, mean arterial pressures were significantly lower in the Group BF than in the Group E and the Group F (p < 0.05). The occurrence of hypotension was significantly lower in the Group BF (9.4%) than in the Group E (18.2%) and the Group F (24.2%). Conclusions: Intrathecal hyperbaric bupivacaine 2.5 mg plus fentanyl 25 mu g administration provides shorter motor block onset time, less local anesthetic usage and adequate hemodynamic stability in elderly patients.Öğe Tracheal intubation without muscle relaxant after induction with remifentanil, S-ketamine and propofol(Lippincott Williams & Wilkins, 2004) Demirbilek, S.; Togal, T.; Gulhas, N.; Ozpolat, Z.; Dogan, Z.; Demir, K.; Ersoy, M. O.[Abstract Not Available]
