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    Comparison between the effects of rocuronium, vecuronium, and cisatracurium using train-of-four and clinical tests in elderly patients
    (Brieflands, 2013) Sagir O.; Yucesoy Noyan F.; Koroglu A.; Cicek M.; Ilksen Toprak H.
    Background: Postoperative residual blockade, longer duration of action for neuromuscular blockade, and slower recovery were relatively common in elderly patients. Objectives: We aimed to investigate the safety of train-of-four ratio and clinical tests in the assessment of patient recovery, and to determine the effects of the rocuronium, vecuronium, and cisatracurium on intubation, extubation and recovery times in elderly patients undergoing abdominal surgery. Patients and Methods: After obtaining institutional approval and informed consent, 60 patients over 60 years old and undergoing elective abdominal operations were included in this double-blind, randomized clinical trial. Following a standard anesthesia induction, 0.6mg kg-1 rocuronium, 0.1mg kg-1 vecuronium, and 0.1mg kg-1 cisatracurium were administered to the patients in Group R, Group V, and Group C, respectively. Train-of-four (TOF) ratios were recorded at 10-minute intervals during and after the operation. Modified Aldrete Score (MAS) and clinical tests were recorded in the recovery room at 10-minute intervals. In addition, intubation and extubation times, duration of recovery room stay, and any complications were recorded. Results: Intubation time was found to be shorter in Group R than that in Groups V and C (P < 0.001). Times to positive visual disturbances and grip strength tests were shorter in Group C than that in Group V (P = 0.016 and P = 0.011, respectively). In Group R and group C, time to TOF ? 0.9 was significantly longer than all positive clinical test times except grip strength (P < 0.05). Conclusions: We hold the opinion that cisatracurium is safer in elderly patients compared to other drugs. We also concluded that the usage of TOF ratio together with clinical tests is suitable for assessment of neuromuscular recovery in these patients. © 2013 Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM); Published by Kowsar Corp.
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    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.