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Öğe Comparison of fentanyl and ketamine addition to bupivacaine for caudal anesthesia in children(2004) Köro?lu A.; Gülhaş N.; Türköz A.; Erdem S.; Ersoy M.Ö.In our study, we aimed to compare the effects of fentanyl and ketamine addition to bupivacaine on the quality of anesthesia, level of sensorial block, duration of motor block, postoperative analgesic requirement and duration of postoperative analgesia for caudal anesthesia in children. One hundred twenty two patients aged between 1-8 years old undergoing inguinal hernia repair were included in the study. Mask anesthesia with sevoflurane was applied during intravenous catheter placement and propofol infusion 1-3mg kg-1 h-1 was given while performing caudal anesthesia and during the operation. In group I (n=43) 2mg kg-1 0.25% bupivacaine, in group II (n=40) 1?g kg-1 fentanyl and 2mg kg-1 0.25% bupivacaine, in group III (n=39) 0.5mg kg-1 ketamine and 2mg kg-1 0.25% bupivacaine was given. Mean blood pressure, heart rate, peripheral oxygen saturation, respiration rate, ETCO2 and total dose of propofol used were recorded. Onset time of block, levels of sensorial block, duration of motor block and postoperative analgesia, total analgesic amount and complications were recorded. Mean level of sensorial block was significantly higher in group II and III than group I. Analgesic requirement after operation was significantly lower in group III than group I. Duration of postoperative analgesia was significantly longer in group III than the other groups. As a conclusion, we decided that fentanyl or ketamine addition to bupivacaine does not affect the quality of caudal anesthesia, but ketamine decreased the analgesic requirement by extending duration of postoperative analgesia.Öğe Comparison of morphine usage in intravenous PCA and epidural PCA(2003) To?al T.; Şahin Ş.; Durmuş M.; Türköz A.; Köro?lu A.; Ayas A.; Ersoy M.Ö.The aim of this study is to compare morphine for postoperative pain management by using intravenous and epidural patient controlled analgesia (PCA), for analgesic efficacy and side effects. After ethical committee approval was obtained, thirty cases aged 30-65 years (ASA I-II) were divided randomly into two groups. Group I received epidural PCA as loading dose morphine 2 mg, basal infusion rate 0.2 mg/h, bolus dose 0.5 mg and lockout time 30 minutes. Group II received intravenous PCA as loading dose morphine 5 mg, basal infusion rate 0.3 mg/h, bolus dose 1 mg and lockout time 15 minutes. Standard general anaesthesia procedure was performed. Procedure was started just after the operation. The mean arterial pressure, heart rate, respiratory rate, Visual Analogue Scale (VAS) and sedation scores were recorded at the end of the operation and at 1st, 2nd, 4th, 8th, 12th, 16th, 20th, 24th hour after the operation. Total morphine consumption, the number of request, the bolus dose delivery rate and side effects were recorded at the end of postoperative 24th hour. During 24 hours, morphine consumption and bolus dose delivery rate was significantly lower in Group I and the number of the request was significantly lower in Group II. There was no statistical difference between the two groups in terms of efficacy and VAS during 24 hours, except for the 8th hour. The VAS rates were below 3, after 8th hour in groups. VAS 8 score was lower in Group I. VAS rates at the hours 1, 2, 4, 8, 12, 16, 20, 24 decreased significantly compared to the rates at the beginning in each of the groups. Sedation scores at 1st, 2nd, 4th and 8th hour in Group I was lower than Group II. Pruritis was higher in Group I. There was no significant statistical difference between the two groups in terms of heart rate, mean arterial pressure and respiratory rate. As a result we conclude that the usage of morphine for the postoperative pain management by epidural or intravenous PCA provide effective analgesia only by short lock-out time and appropriate loading and bolus close.Öğe Does the supplementation of fentanyl to bupivacaine affect unilateral spinal block?(2001) Durmuş M.; Türköz A.; To?al T.; Ayas A.; Öztürk E.; Ersoy M.O.The purpose of this study was to evaluate the affects of supplementation of fentanyl to rapid administered low dose hyperbaric bupivacaine for unilateral spinal anaesthesia in arthroscopic surgery. Thirty patients undergoing arthroscopic surgery were placed in the lateral position. After dural puncture (25-gauge Whitacre spinal needle), the needle hole was turned toward the dependent side and patients were randomly assigned to receive 7.5 mg of 0.5 % hyperbaric bupivacaine (Group I, n=15) or 7.5 mg of 0.5 % hiperbaric bupivacaine + 25 ?g fentanyl (Group II, n=15). Lateral and horizontal positions were maintained for 15 min before the patients were turned to supine position. Sensory block levels were assessed with three minutes intervals during lateral position and 5 minutes intervals during supine position and motor block levels were assessed with 15 minutes intervals. Spinal anaesthesia was unilateral in 80 % of group I and 13 % of group II at the end of the 15 min; after 60 min, spinal anaesthesia was unilateral in 80 % of group I and 0 % of group II (p<0.005). We conclude that fentanyl supplementation to low dose hyperbaric bupivacaine was disadvantageous in obtaining unilateral spinal anaesthesia although we can obtain long-term sensory block.Öğe Effect of intratechal morphine on postoperative stress response and postoperative analgesic requirements on cardiac patients in major abdominal surgery(2000) To?al T.; Türköz A.; Durmuş M.; Şahin S.; Yilmaz S.; Ersoy M.Ö.This study investigated the use of single dose intratechal (IT) morphine on cardiac patients undergoing major abdominal surgery and its effect on postoperative stress response, hemodynamic response and postoperative analgesic requirements. ASA class III 20 patients were randomized to receive either 10 ?g/kg of intratechal morphine or control group. Induction were performed by fentanyl 5 ?g/kg, thiopentone 2-4 mg/kg and vecuronium 0.08 mg/kg and anaesthesia was maintained by 33% N2O/O2 mixture with sevoflurane. There were no significant differences in the serum cortisol, glucose, BUN, creatinine, ALP, ALT, AST, CK, CK-MB concentrations recorded in the two groups pre and postoperatively. Cortisol, CK and CK-MB concentrations increased in both groups postoperatively. Plasma glucose concentrations increased in control group postoperatively. There were no significant differences of hemodynamic parameters between the two groups. Analgesic requirements of control group increased postoperatively comparing IT group. Three patients died postoperatively, other side effects were clinically insignificant. In conclusion IT morphine had no effect upon hemodynamic response, did not inhibit the stress response to surgery perioperatively on cardiac patients but we demonstrated the decrease of the postoperative analgesic requirements.Öğe 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.Öğe The effect of oral clonidine on postoperative nausea and vomiting in children undergoing strabismus surgery(2001) Gülhaş N.; Türköz A.; Bayramlar H.; Durmuş M.; Gedik E.; Da?lio?lu M.C.; Ersoy M.Ö.We aimed to investigate the effect of oral clonidine on postoperatory nausea and vomiting (PONV) in forty patients who underwent strabismus surgery. Patients were divided into two groups in this randomized and double blind prospective study. In Group I (n=20), patients were orally administered 4 ?g/kg clonidine within 0.2 mL/kg apple juice one hour before surgery. Group II, the control Group, were given only apple juice in same volume. Anesthesia was induced by atropine 0.02 mg/kg, lidocaine 2 mg/kg, propofol 3 mg/kg and vecuronium 0.1 mg/kg. Sevoflurane 2 % and N20 60 % in oxygen 40 % was used for maintenance The nausea and vomiting episodes were scored from 0 to 3 as follows: score 0: no nausea-vomiting; score 1: only nausea; score 2: some nausea-vomiting not needed treatment; score 3: severe vomiting needing treatment (metoclopramide 0.15 mg/kg). Nausea and vomiting was observed in five children in Group I (25 %) and in 8 children in Group II (40 %) (p<0.05) in first 6 hours of postoperative period. During first 48 hours, the rate of nausea and vomiting increased to 8 (40 %) and 12 (60 %) children in Group I and II, respectively (p<0.05). There was no statistically significant difference between two groups at other intervals. In conclusion clonidine which is given orally preoperatively reduced the rate of PONV in children who underwent strabismus surgery.Öğe The effects of lidocaine filled endotracheal tube cuff on extubation responses(2001) Durmuş M.; To?al T.; Türköz A.; Gedik E.; Özturk E.; Ersoy M.Ö.This study was undertaken to evaluate the effects of lidocaine and alcalinized lidocaine filled endotracheal tube cuffs on extubation responses. Thirty five patients of Asa class I-II undergoing elective surgery were included. They were randomly assigned into three groups. After tracheal intubation, the endotracheal tube cuff was filled with one of the following solutions: serum physiologic (group A, n:12), 4 % lidocaine (group B, n:12) and 4 % lidocaine 4 ml + 8.4 % NaHCO3 1 mL (group C, n:11). Changes in heart rate, systolic, mean and diastolic arterial pressures were measured before and 1.3 and 5 min after tracheal extubation. Side effects such as coughing, sore throat, laryngospasm, bronchospasm, nausea and vomiting was evaluated after tracheal extubation and in recovery period. There was no statistically significant difference between three groups regarding to hemodynamic changes and adverse effects. We concluded that filling the endothraceal tube cuff with lidocaine or alcalinized lidocaine can not affect the heart rate and blood pressure increase which are seen after extubation and can not reduce the frequency of other side effects.Öğe 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.
