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    Carbon dioxide pneumothorax during laparoscopic surgery.
    (2002) Togal T.; Gulhas N.; Cicek M.; Teksan H.; Ersoy O.
    BACKGROUND: Anesthetic considerations for laparoscopic cholecystectomy are similar to those for other laparoscopic procedures and result from the creation of a pneumoperitoneum by insufflation of carbon dioxide (CO 2) into the abdominal cavity. The resultant problems such as decreased functional residual capacity, increased airway pressure, hypercarbia, and circulatory impairment are well known [1]. The reported case is that of a healthy 45-yr-old man who underwent elective laparoscopic cholecystectomy under general anesthesia. As surgery proceeded he developed hypercapnia (arterial blood partial pressure of CO 2 [pCO] 2], 97.1 mmHg; extrapolated end-tidal CO 2 tension [P ETCO 2], 90 mmHg) and hypoxemia (partial pressure of oxygen [pO 2], 53.1 mmHg). The cause was attributed to absorption of CO 2 directly related to the surgical pneumoperitoneum. This report illustrates the diagnosis and management of an unusual case of CO 2 absorption, resulting in hypercapnia and hypoxemia, and a spontaneous recovery within 30 to 60 min without need of thoracentesis.
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    Combination of low-dose (0.1 mg) intrathecal morphine and patient-controlled intravenous morphine in the management of postoperative pain following abdominal hysterectomy
    (2004) Togal T.; Demirbilek S.; Gulhas N.; Koroglu A.
    The aim of this double-blind prospective randomized study was to investigate combination of low-dose (0.1 mg) intrathecal morphine and patient-controlled intravenous morphine in the management of postoperative pain following abdominal hysterectomy. Side-effects, satisfaction and sedation were also evaluated. Fifty patients (ASA I) between 30 and 65 years of age, scheduled for elective abdominal hysterectomy were randomized to receive intrathecal 0.1 mg of morphine sulfate (ITM) or placebo and intravenous morphine (IVM). Both groups received standard general anesthesia. In the ITM group, 0.1 mg morphine was administered intrathecally just before emergence from anesthesia while an equal volume of sterile saline was administered in the IVM group. Thereafter, all patients received IV morphine via a patient controlled analgesia (PCA) pump, set to deliver a bolus of 1 mg with a lock-out of 7 minutes and maximum dose of 20 mg per 4 hours. Hemodynamics, respiration, PCA demands, VAS, sedation scores, total morphine consumption, satisfaction and side effects were recorded for 24 hours after surgery. There were no significant differences between the groups with respect to satisfaction score. Total morphine consumption was lower in the ITM group; VAS scores at the first 8 hours were lower in the ITM group. Sedation scores at 4, 8, and 12th hours were higher in the ITM group. There was no significant difference in terms of adverse effects. In conclusion, intrathecal morphine (0.1 mg) combined with intravenous PCA is a safe and effective method of providing analgesia after hysterectomy as evidenced by lower pain scores and total morphine consumption and improved patient satisfaction.
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    Comparison of preoperative and postoperative approaches to ultrasoundguided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy
    (Scientific Publishers of 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. © 2017, Scientific Publishers of India. All rights reserved.
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    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.