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Öğe Does leflunomide attenuate the sepsis-induced acute lung injury?(Springer, 2008) Ozturk, Erdogan; Demirbilek, Semra; Begec, Zekine; Surucu, Murat; Fadillioglu, Ersin; Kirimhoglu, Hale; Ersoy, M. OzcanThe organ that is affected first and most severely in intraabdominal sepsis is the lung. Oxygen radicals and active neutrophils in the lung are important sources for severe pulmonary inflammation leading to acute lung injury (ALI)/acute respiratory distress syndrome. The aim of this study was to investigate the effects of leflunomide, an immunomodulatory agent, on oxidant/antioxidant status with nitric oxide (NO) level and myeloperoxidase (MPO) activity in rats with sepsis-induced ALI. Fifty male Wistar albino rats were divided into five groups: control, sham, sepsis, leflunomide (10 mg/kg, intragastrically for two doses with an 8 h interval prior to the experiment) and sepsis + leflunomide. After the animals were anesthetized with ketamine and xylazine, the abdominal cavity was opened and ligated just below the ileocaecal valve with 3-0 silk. The antimesentric surface of the cecum was perforated and the cecum was gently compressed until fecal matter was extruded to induce sepsis. None of the rats received antibiotics during the experimental procedures. The experiment was ended 24 h after cecal ligation puncture (CLP) with the cervical dislocation under anesthesia. The lung tissues were removed for analysis of biochemical parameters and light microscopic investigation. The lung superoxide dismutase (SOD), catalase and glutathione peroxidase activities were decreased in the sepsis group as compared to the group control, sham, leflunomide and sepsis + leflunomide (P < 0.05), and SOD activity were significantly higher in group sepsis + leflunomide than sham, control, leflunomide and sepsis group (P < 0.05). The lung MPO, malondialdehyde (MDA), protein carbonyl and NO levels were higher in the sepsis group when compared to group control, sham, leflunomide and sepsis + leflunomide (P < 0.05), and MPO, MDA and NO levels were higher in the sepsis + leflunomide group than in the sham, control and leflunomide group (P < 0.05). The light microscopic evaluation showed that pulmonary architecture was preserved, and infiltration of neutrophil and edema decreased in sepsis + leflunomide group. The grade of alveolar damage was significantly decreased in sepsis + leflunomide group in comparison with sepsis group (P < 0.05). Our findings suggested that leflunomide attenuated the lung injury after CLP-induced sepsis by inhibition of neutrophils accumulation and increasing endogenous antioxidant capacity.Öğe Effects of 2 Different Doses of Pregabalin on Morphine Consumption and Pain After Abdominal Hysterectomy: A Randomized, Double-Blind Clinical Trial(Elsevier, 2011) Yucel, Aytac; Ozturk, Erdogan; Aydogan, M. Said; Durmus, Mahmut; Colak, Cemil; Ersoy, M. OzcanBACKGROUND: Pregabalin has a similar pharmacologic profile to that of its developmental predecessor gabapentin but has shown greater analgesic activity in rodent models of neuropathic pain. OBJECTIVE: The objective of the study was to compare the effects of 2 different doses of pregabalin and placebo on postoperative pain and morphine consumption. METHODS: Ninety patients who underwent abdominal hysterectomy were included in the study and randomly divided into 3 groups in a doubled-blinded manner. They were given 150 mg of pregabalin (group P300, n = 30), 300 mg of pregabalin (group P600, n = 30), or placebo capsules (group C, n = 30) 4 hours before the induction of anesthesia; they received a second dose of the drug 12 hours postoperatively. Morphine consumption, nausea, and vomiting, visual analogue scale-pain intensity (VAS-PI), sedation scores, and dissatisfaction scores were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 hours after operation. RESULTS: Morphine consumption at 24 hours was 40.80 (3.42) mg, 33.79 (5.77) mg, and 46.97 (6.67) mg in groups P300, P600, and C, respectively (P < 0.001). VAS-PI scores at movement and at rest in the PACU and at 2, 4, and 6 hours decreased in group P600 (P < 0.01). In the PACU and at 2, 4, and 6 hours, the sedation scores were increased in group P600 compared with the scores in group C (P < 0.001, P < 0.001, P = 0.01, P = 0.006, respectively). Patient satisfaction was higher in group P600 than in group C for all time points (P < 0.001, P < 0.001, P < 0.001, P = 0.001, P < 0.001, respectively). There were no statistically significant differences between the groups for side effects such as nausea, vomiting, and dizziness (P = 0.58). CONCLUSIONS: Pregabalin at a total dose of 600 mg, administered before operation and at 12 hours postoperatively after abdominal hysterectomy, reduced morphine consumption and pain intensity and increased patient satisfaction. No significant differences in side effects were observed between the study groups. (Curr Ther Res Clin Exp. 2011;72:173-183) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.Öğe The effects of cognitive impairment on anaesthetic requirement in the elderly(Lippincott Williams & Wilkins, 2012) Erdogan, Mehmet A.; Demirbilek, Semra; Erdil, Feray; Aydogan, Mustafa S.; Ozturk, Erdogan; Togal, Turkan; Ersoy, Mehmet O.Context Patients with dementia have a lower bispectral index score (BIS) when awake than age-matched healthy controls. Objectives The primary aim was to compare the BIS and the dose of propofol required for induction in patients suffering from cognitive impairment with that in those who had normal cognitive function. This study also evaluated the effects of cognitive impairment in the elderly on anaesthetic agent consumption during surgery and on emergence from anaesthesia. Design and setting This randomised controlled study was carried out in a university hospital. Patients over 65 years of age, ASA I-II and scheduled for elective orthopaedic procedures were allocated to one of two groups. Interventions Patients (n = 92) were allocated according to their Mini Mental State Examination score: 25 or higher (group 1) or 21 or less (group 2). All patients received propofol 0.5 mgkg(-1) following the commencement of a remifentanil infusion at 0.5 mu gkg(-1) min(-1). After incremental doses of propofol up to loss of consciousness, a propofol infusion was started at 75 mu gkg(-1) min(-1). Propofol and remifentanil infusion doses were adjusted to keep the BIS value between 45 and 60 during surgery. Main outcome measure MMSE score was evaluated 24 h before and after surgery. The anaesthetic consumption, mean arterial pressure, HR and BIS values of the patients were recorded. Results Before surgery, mean Mini Mental State Examination scores were 26.8 +/- 1.6 and 16.6 +/- 4.2 in group 1 and 2, respectively. These returned to baseline value 24 h after surgery in group 1 (26.6 +/- 1.5) and group 2 (15.6 +/- 4.3). Before induction, four of 45 patients (8.9%) in group 1 had a BIS value less than 93 compared with 13 of 47 (27.7%) in group 2 (P = 0.02). The mean BIS value was significantly lower in group 2 than in group 1 before induction, during loss of consciousness, 3 and 5 min after discontinuation of the anaesthetic agents and before extubation (P < 0.05). The induction dose of propofol was lower in group 2 than in group 1 (P = 0.02). The eye opening time was significantly longer in group 2 than in group 1 (P = 0.03). Conclusion The baseline BIS value was lower in patients with cognitive impairment than in those with normal cognitive function. The former received less propofol during induction and eye opening time was longer. On the basis of our findings from the recovery period, we suggest that the recommended target BIS value for adequate anaesthesia in the general population is inappropriate for patients with cognitive impairment. Eur J Anaesthesiol 2012; 29:326-331Öğe Effects of Propofol or Etomidate on QT Interval During Electroconvulsive Therapy(Lippincott Williams & Wilkins, 2009) Erdil, Feray; Demirbilek, Semra; Begec, Zekine; Ozturk, Erdogan; Ersoy, Mehmet OzcanBackground: Because patients with major depression have an altered autonomic nervous system activity, the risk of arrhythmias and sudden cardiac death may be increased. In addition, electroconvulsive therapy (ECT) may cause an acute rise in QT dispersion, which may predispose to arrhythmias. In this study, we investigated the effects of propofol or etomidate on the corrected QT (QTc) interval during ECT in patients with major depression. Materials and Methods: Fourteen unpremedicated American Society of Anesthesiologists 1 patients, each scheduled for 6 ECT sessions for major depression, were included in a prospective, randomized crossover study The patients randomly received either 1-mg/kg propofol (propofol group) or 0.2-mg/kg etomidate (etomidate group). The mean arterial pressure (MAY), heart rate (HR), and electrocardiogram were recorded before anesthetic induction, 0 and 1 minute after the seizure ended, and 3 and 10 minutes after the seizure ended (T3 and T4, respectively). Results: In the propofol group, the QTc interval was shorter than the baseline at 0 minute after the seizure ended. The QTc interval increased from the baseline at T3 and T4 in the etomidate group. In the etomidate group, the QTc interval was longer at T3 and T4 than that in the propofol group (P < 0.05). In the etomidate group, the HR increased at T3 and T4, but the MAP increased at all measurement times from the baseline value. The HR and the MAP were lower at T3 and T4 in the propofol group than in the etomidate group (P < 0.05). Conclusions: Propofol did not induce prolongation of the QT interval and controlled the hemodynamic response better than etomidate during ECT. Therefore, propofol may be more suitable than etomidate for ECT treatments.Öğe The effects of secondhand smoke on postoperative pain and fentanyl consumption(Springer Japan Kk, 2013) Aydogan, Mustafa Said; Ozturk, Erdogan; Erdogan, Mehmet Ali; Yucel, Aytac; Durmus, Mahmut; Ersoy, Mehmet Ozcan; Colak, CemilAlthough the need for increased postoperative analgesia in smokers has been described, the effect of secondhand smoke on postoperative analgesia requirements has not been studied. We examined the effects of secondhand smoke on fentanyl consumption and postoperative pain. In this study, 101 patients (American Society of Anesthesiology physical status I and II) who underwent abdominal hysterectomy were divided into 3 groups according to history of exposure to cigarette smoke as per medical records which was retrospectively confirmed by measurement of serum cotinine: smokers (n = 28), nonsmokers (n = 31), and secondhand smokers (n = 32). All patients received propofol-remifentanil total intravenous anesthesia and used fentanyl patient controlled analgesia for postoperative pain. The fentanyl consumption visual analogue scale-pain intensity (VAS-PI) score and side effects were recorded in the postanesthesia care unit (PACU) and at 2, 4, 6, and 24 h after surgery. Fentanyl consumption at all the evaluation time points was significantly higher in secondhand smokers than in nonsmokers (P < 0.05). However, fentanyl consumption in secondhand smokers was lower than that in smokers in the PACU and at 24 h (P < 0.05). VAS-PI scores during movement and at rest in the PACU and at 4, 6, and 24 h after surgery were higher in secondhand smokers than in nonsmokers (P < 0.05). There were no statistically significant differences between the groups with regard to side effects such as nausea, vomiting, and dizziness (P > 0.05). Secondhand smoking was associated with increased postoperative fentanyl consumption, and increased VAS-PI scores. These findings may be beneficial for managing postoperative pain in secondhand smokers.Öğe Propofol and erythropoietin antioxidant properties in rat brain injured tissue(Pergamon-Elsevier Science Ltd, 2008) Ozturk, Erdogan; Demirbilek, Semra; Koroglu, Ahmet; But, Abdulkadir; Begec, Zekine Oezpolat; Gulec, Mukaddes; Akyol, OmerSo far, several treatment modalities have been attempted to brain protection in cases such as brain trauma, stroke or brain hemorrhage. However, a treatment method that the effect begins immediately and definitely helpful has not been discovered yet. In this study, we aimed to compare the effects of propofol and erythropoietin (Epo) on brain injury caused by oxidative stress and antioxidant properties of these agents after closed head injury (CHI) in rats. For this study, female Wistar Albino rats were divided into five groups: non-traumatic control group, trauma performed group CHI, trauma with propofol (100 mg/kg) intraperitoneally (i.p.), trauma with Epo (5000 U/kg) i.p. and trauma with propofol and Epo performed study groups. Twenty-four hours after CHI, rats were sacrificed and the brains were removed. Superoxide dismutase (SOD), catalase (CAT), xanthine oxidase (XO), nitric oxide (NO), and malondialdehyde (MDA) levels were measured in brain tissue. MDA and NO levels were decreased significantly in Groups Epo, Propofol and Epo + Propofol than Group CHI (p < 0.0 1). XO activity was significantly lower in Group Epo than Group CHI (p <0.05). Epo and propofol decreased oxidative stress by decreasing MDA and NO level in brain tissue after CHI. However, combination of Epo and propofol has no significant beneficial advantage than Epo or propofol alone. (c) 2007 Elsevier Inc. All rights reserved.Öğe Protective effect of leflunomide against oxidative intestinal injury in a rodent model of sepsis(Academic Press Inc Elsevier Science, 2014) Ozturk, Erdogan; Surucu, Murat; Karaman, Abdurrahman; Samdanci, Emine; Fadillioglu, ErsinBackground: Sepsis is defined as an uncontrolled inflammatory response in a host. The process may lead to severe sepsis, multisystem organ failure and even death. Leflunomide has important immunomodulatory and anti-inflammatory effects, which may mitigate host response to bacterial translocation. The goal of our study was to measure the effects leflunomide administration had on a variety of biochemical markers upregulated in systemic inflammatory response syndrome, sepsis, and multiple organ failure syndrome. Materials and methods: Wistar albino type rats were randomly divided into five groups: control, sham, leflunomide, sepsis, and sepsis + leflunomide. Sepsis was achieved by means of the cecal ligation and puncture method. Leflunomide 2 x 10 mg/kg/d was administered before the experiment. At the end of 24 h, the tissue levels of superoxide dismutase, catalase activity, malondialdehyde, nitric oxide, and protein carbonyl were measured. Results: The level of the bowel superoxide dismutase and catalase levels of the sepsis group is significantly lower than those of the control, sham, and leflunomide groups (P < 0.05). Malondialdehyde, nitric oxide, and protein carbonyl levels are significantly higher in sepsis compared with other groups (P < 0.05). Conclusions: Leflunomide's prevention of protein and lipid peroxidation was observed in septic bowel tissue. Use of leflunomide could have protective effects against both the onset and the progressive stages of sepsis. Crown Copyright (c) 2014 Published by Elsevier Inc. All rights reserved.Öğe Remifentanil and propofol for tracheal intubation without muscle relaxant in children: the effects of ketamine(Lippincott Williams & Wilkins, 2009) Begec, Zekine; Demirbilek, Semra; Ozturk, Erdogan; Erdil, Feray; Ersoy, M. OzcanBackground and objective Remifentanil and propofol have been proposed for intubation without muscle relaxant to avoid the adverse effects of muscle relaxants in children. We hypothesized that the addition of ketamine to remifentanil and propofol would improve intubating conditions and provide haemodynamic stability. Methods We studied 88 children (3-12 years) undergoing elective surgery. Group K received ketamine 0.5 mg kg(-1), remifentanil 3 mu g kg(-1) and propofol 3 mg kg(-1). Group C received isotonic saline instead of ketamine, all other study drugs were same as in group K. Sixty seconds after administration of propofol, laryngoscopy and tracheal intubation were performed. Intubating conditions were graded. Mean arterial pressure (MAP), heart rate (HR) and SPO2 were recorded. Results The intubating conditions were regarded as clinically acceptable in 39 out of 44 (89%) children in group K and in 36 out of 44 (82%) children in group C. Although there was no failed intubation in group K, the intubation failed in six children in group C (P<0.05). Tracheal intubation failed in 4/6 children because of severe coughing and/or limb movement, and in 2/6 children because of closed vocal cords. Scores for limb movement were significantly lower in group K than in group C. When compared with baseline, HR and MAP significantly decreased in both groups during the study (P<0.05). Conclusion The addition of ketamine to remifentanil and propofol prevented failed intubation and slightly increased the percentage of acceptable intubating conditions. Ketamine had no influence on haemodynamic changes following remifentanil and propofol administration in given doses. Eur J Anaesthesiol 26:213-217 (C) 2009 European Society of Anaesthesiology.
