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Öğe Anaesthetic Management in Obstructive Sleep Apnea Syndrome for Adenotonsillectomy(Aves, 2014) Sanli, Mukadder; Toplu, Yuksel; Ozgul, Ulku; Kayhan, Gulay Erdogan; Gulhas, NurcinThe anaesthetic management of adenotonsillectomy in children with obstructive sleep apnea syndrome was characteristic due to respiratory and cardiac side effects. A detailed physical examination in the preoperative period should be performed, including children's respiratory and cardiac systems. If they have an active infection, surgery should be postponed until the end of medical treatment. Preparation for difficult airway management should be done in the preoperative period. In this case, we presented a report of two children who had obstructive sleep apnea syndrome, with airway management performed at the right lateral position to prevent the pharyngeal collapse and rapid sequence intubation performed using a short-acting muscle relaxant.Öğe Comparison of intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery: A randomized controlled trial(Elsevier Science Inc, 2018) Kayhan, Gulay Erdogan; Sanli, Mukadder; Ozgul, Ulku; Kirteke, Ramazan; Yologlu, SaimStudy objective: Multimodal analgesic strategies are recommended to decrease opioid requirements and opioid-induced respiratory complications in patients undergoing laparoscopic bariatric surgery. Recent studies have demonstrated that intravenous ibuprofen decreases opioid consumption compared with placebo. The primary aim of this study was to compare the effect of intravenous ibuprofen and intravenous acetaminophen on opioid consumption. We also aimed to compare postoperative pain levels and side effects of the drugs. Design: Randomized, double-blinded study. Setting: University hospital. Patients: Eighty patients, aged 18-65 years, (ASA physical status undergoing laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass surgery were included in this study. Interventions: Patients were randomized to receive 800 mg ibuprofen or 1 g acetaminophen intravenously every 6 h for the first 24 h following surgery; in addition, patient-controlled analgesia with morphine was administered. Measurements: Postoperative morphine consumption in the first 24 h, visual analog scale (VAS) pain scores at rest and with movement, and opioid related side effects were assessed. In addition, time to passage of flatus, surgical complications, lengths of intensive care unit and hospital stay, and laboratory parameters were recorded. Main results: The mean morphine consumption was 23.94 +/- 13.89 mg in iv ibuprofen group and 30.23 +/- 13.76 mg in the acetaminophen group [mean difference: -6.28 (95% CI, -12.70, 0.12); P = 0.055]. The use of intravenous ibuprofen was associated with reduction in pain at rest (AUC, 1- to 24-h, P < 0.001 and 12- to 24-h, P = 0.021) and pain with movement (AUC, 1-24, 6-24, and 12-24 h, P < 0.001). Intravenous ibuprofen was well tolerated with no serious side effects except dizziness. Conclusions: Intravenous ibuprofen did not significantly reduce opioid consumption compared to intravenous acetaminophen; however, it reduced the severity of pain. Intravenous ibuprofen may be a good alternative to intravenous acetaminophen as part of a multimodal postoperative analgesia in patients undergoing bariatric surgery.Öğe The comparison of levobupivacaine in continuous or single dose spinal anesthesia for transurethral resection of prostate surgery(Elsevier Science Inc, 2014) Baydilek, Yunus; Yurtlu, Bulent Serhan; Hanci, Volkan; Ayoglu, Hilal; Okyay, Rahsan Dilek; Kayhan, Gulay Erdogan; Tokgoz, HusnuBackground: The aim of the study is to compare the efficacy of levobupivacaine induced continuous spinal anesthesia (CSA) versus single dose spinal anesthesia (SDSA) in patients who are planned to undergo transurethral prostate resection. Methods: Sixty years or older, ASA I-II or III, 50 patients were included in the study. 12.5 mg 0.5% levobupivacaine were administered intrathecally in SDSA group. In CSA group, initially 2 mL of 0.25% levobupivacaine were administered through spinal catheter. In order to achieve sensory block level at 110 dermatome, additional 1 mL of 0.25% levobupivacaine were administered through the catheter in every 10 min. Hemodynamic parameters and block characteristics were recorded. Preoperative and postoperative blood samples of the patients were drawn to determine plasma cortisone and plasma epinephrine levels. Results: CSA technique provided better hemodynamic stability compared to SDSA technique particularly 90 min after intrathecal administration. The rise in sensory block level was rapid and the time to reach surgical anesthesia was shorter in SDSA group. Motor block developed faster in SDSA group. In CSA group, similar anesthesia level was achieved by using lower levobupivacaine dose and which was related to faster recovery. Although, both techniques were effective in preventing surgical stress respond, postoperative cortisone levels were suppressed more in SDSA group. Conclusion: CSA technique with 0.25% levobupivacaine can be used as a regional anesthesia method for elderly patients planned to have TUR-P operation. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe Dexmedetomidine ameliorates TNBS-induced colitis by inducing immunomodulator effect(Academic Press Inc Elsevier Science, 2013) Kayhan, Gulay Erdogan; Gul, Mehmet; Kayhan, Basak; Gedik, Ender; Ozgul, Ulku; Kurtoglu, Elcin Latife; Durmus, MahmutBackground: Since sedatives are often administered to immune-compromised and critically ill patients, our understanding of immunomodulation by sedation will be critical. Dexmedetomidine, a selective alpha(2)-adrenergic receptor agonist, is often used for sedation and analgesia especially in intensive care units. There are conflicting and little data concerning both the effect and the mechanism of dexmedetomidine on immune response. In our study, we aimed to investigate the effect of dexmedetomidine on immune system at two different doses (5 mu g.kg(-1) and 30 mu g.kg(-1)) during inflammatory bowel disease by using an experimental model, which resembles both systemic and local inflammation. Methods: The effect of dexmedetomidine on the course of inflammatory bowel disease was investigated by measuring macroscopic and microscopic parameters. We investigated pro-inflammatory Th1, Th2, and Th17 cytokine levels in serum samples to analyze systemic immune response. Following this, local immune response was investigated by measuring cytokine levels in the presence of dexmedetomidine in spleen cell culture. Results: Dexmedetomidine administration led to amelioration of all disease associated pathological manifestations. According to our in vitro and in vivo results, dexmedetomidine shows anti-inflammatory effect by increasing IL-4 and IL-10 levels responsible from anti-inflammatory response via Th2 pathway. Moreover, we showed for the first time in the study that dexmedetomidine administration reduces IL-23, which is responsible from initiation of inflammatory response via Th17 pathway. Conclusions: Dexmedetomidine can have beneficial effect on preoperative or postoperative inflammatory bowel disease patients in intensive care units by down-regulating inflammatory immune response not only in systemic circulation but also in tissue-specific manner. (c) 2013 Elsevier Inc. All rights reserved.Öğe Effects of sevoflurane or ketamine on the QTc interval during electroconvulsive therapy(Springer Japan Kk, 2015) Erdil, Feray; Begec, Zekine; Kayhan, Gulay Erdogan; Yologlu, Saim; Ersoy, Mehmet Ozcan; Durmus, MahmutTo evaluate the effect of sevoflurane or ketamine on the corrected QT (QTc) interval and the interval from the peak to the end of the T wave (Tp-e) during electroconvulsive therapy (ECT) in patients with major depression. This prospective, randomized, double-blinded study included 24 patients that were randomly allocated to receive sevoflurane (group S) or ketamine (group K) for ECT session. Group S patients received 8 % sevoflurane for anesthesia induction, which was maintained at 2-4 % until delivery of the electrical stimulus. Group K patients received a bolus of ketamine (1 mg/kg). The mean arterial pressure (MAP) and heart rate (HR) and the electrocardiogram (ECG) were recorded before (T1) and after induction of anesthesia (T2) and 0, 1, 3, and 10 min after the electrical stimuli ended (T3, T4, T5, and T6, respectively). In both groups, the QTc interval was significantly longer at T2, T4, T5, and T6 than at baseline. The QTc interval was longer at T4, T5, and T6 in group S compared to that in group K, the Tp-e interval was significantly longer at T4 in group K both baseline and group S. The HR in group S was increased at T4 compared with group K. MAP was significantly higher after induction of anesthesia in group K compared to those in group S at all time points. Although group S showed a prolonged QTc interval after ECT compared to group K, the Tp-e interval in both groups was not significantly affected clinically. Sevoflurane blunted MAP and peak HR.Öğe Emergency Difficult Airway Management in a Patient with Severe Epidermolysis Bullosa(Aves, 2016) Ozkan, Ahmet Selim; Kayhan, Gulay Erdogan; Akbas, Sedat; Kacmaz, Osman; Durmus, MahmutEpidermolysis bullosa (EB) is a rare disease characterised by vesiculobullous lesions with minimal trauma to the skin and mucous membranes. Bleeding, scar tissue, contractures, oedema and lesions that can spread throughout the body can cause a difficult airway and vascular access in patients with EB. Therefore, anaesthetic management in patients with EB is a major problem even for experienced anaesthesiologists. Herein, we report a case of difficult airway management in a patient diagnosed with severe EB who presented for emergency tracheostomy because of respiratory failure under general anaesthesia.Öğe Evaluation of pleth variability index as a predictor of fluid responsiveness during orthotopic liver transplantation(Wiley, 2016) Konur, Huseyin; Kayhan, Gulay Erdogan; Toprak, Huseyin Ilksen; Bucak, Nizamettin; Aydogan, Mustafa Said; Yologlu, Saim; Durmus, MahmutFluid management is challenging and still remains controversial in orthotopic liver transplantation (OLT). The pleth variability index (PVI) has been shown to be a reliable predictor of fluid responsiveness of perioperative and critically ill patients; however, it has not been evaluated in OLT. This study was designed to examine whether the PVI can reliably predict fluid responsiveness in OLT and to compare PVI with other hemodynamic indexes that are measured using the PiCCO(2) monitoring system. Twenty-five patients were enrolled in this study. Each patient was monitored using the noninvasive Masimo and PiCCO(2) monitoring system. PVI was obtained with a Masimo pulse oximeter. Cardiac index was obtained using a transpulmonary thermodilution technique (CITPTD). Stroke volume variation (SVV), pulse pressure variation, and systemic vascular resistance index were measured using the PiCCO(2) system. Fluid loading (10 mL/kg colloid) was performed at two different phases during the operation, and fluid responsiveness was defined as an increase in CITPTD >= 15%. During the dissection phase and the anhepatic phase, respectively, 14 patients (56%) and 18 patients (75%) were classified as responders. There were no differences between the baseline values of the PVI of responders and nonresponders. Area under the curve for PVI was 0.56 (sensitivity 35%, specificity 90%, p = 0.58) at dissection phase, and was 0.55 (sensitivity 55%, specificity 66%, p = 0.58) at anhepatic phase. Of the parameters, a higher area under the curve value was found for SVV. We conclude that PVI was unable to predict fluid responsiveness with sufficient accuracy in patients undergoing OLT, but the SVV parameter was reliable. Copyright (C) 2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC.
