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    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.
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    Haemodynamic effects of isoflurane and sevoflurane in pulmonary hypertensive mitral valve stenosis
    (2002) Kadir But A.; Türköz A.; Durmuş M.; Toprak H.I.; Çolak C.; Özcan Ersoy M.
    Although isoflurane and sevoflurane are widely used in cardiac surgery for their clinical properties, sufficient studies on their cardiovascular and pulmonary effects in mitral stenotic patients with pulmonary hypertension have not been found. Forty patients with mitral stenosis and pulmonary hypertension, who were undergoing mitral valve replacement surgery, were randomly divided into Isoflurane (Gi, n=20) and Sevoflurane (Gs, n=20) groups. After anaesthesia induction, the maintenance of anaesthesia was provided with 1 MAC izoflurane in Gi and 1 MAC sevoflurane in Gs. Hemodynamic measurements, central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), pulmonary vascular resistance index (PVRI) and systemic vascular resistance index (SVRI), were performed before anaesthesia induction (t0), after intubation (t1), and just before cardiopulmonary bypass (t2). Heart rates (HR) and mean arterial pressure (MAP) were also determined t0, t1 and t2 as well as during incisron (ti) and sternotomi (ts) In inter-group evaluation, HR were found to be different at t2 (p<0.05). In-group evaluation, there was statistically significant decrease at t2 compared to t0 in Gs. Inter-group evaluation revealed no significant difference in the other hemodynamic measurements. In-group evolution, MAP, MPAP, PCWP and CI decreased at t1 and t2 compared to t0 in both groups, but CVP declined only at t2 compared to t0. As a result, 1 MAC isoflurane and sevoflurane used in mitral stenotic patients with pulmonary hypertension caused a decrease in MAP, MPAP, and CVP, which is not necessary to be corrected and the decrease in CI was clinically acceptable. According to results of the study, both agents have been thought to be convenient to be used in patients with mitral stenosis with pulmonary hypertension.