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Öğe Anaesthesia for Caesarean section in the presence of aortic coarctation [5](Greenwich Medical Media Ltd, 2002) Togal T.; Durmus M.; Koroglu A.; Demirbilek S.; Karaaslan K.; Ersoy O.[No abstract available]Öğe Carbon dioxide pneumothorax during laparoscopic surgery.(2002) Togal T.; Gulhas N.; Cicek M.; Teksan H.; Ersoy O.BACKGROUND: Anesthetic considerations for laparoscopic cholecystectomy are similar to those for other laparoscopic procedures and result from the creation of a pneumoperitoneum by insufflation of carbon dioxide (CO 2) into the abdominal cavity. The resultant problems such as decreased functional residual capacity, increased airway pressure, hypercarbia, and circulatory impairment are well known [1]. The reported case is that of a healthy 45-yr-old man who underwent elective laparoscopic cholecystectomy under general anesthesia. As surgery proceeded he developed hypercapnia (arterial blood partial pressure of CO 2 [pCO] 2], 97.1 mmHg; extrapolated end-tidal CO 2 tension [P ETCO 2], 90 mmHg) and hypoxemia (partial pressure of oxygen [pO 2], 53.1 mmHg). The cause was attributed to absorption of CO 2 directly related to the surgical pneumoperitoneum. This report illustrates the diagnosis and management of an unusual case of CO 2 absorption, resulting in hypercapnia and hypoxemia, and a spontaneous recovery within 30 to 60 min without need of thoracentesis.Öğe Combination of low-dose (0.1 mg) intrathecal morphine and patient-controlled intravenous morphine in the management of postoperative pain following abdominal hysterectomy(2004) Togal T.; Demirbilek S.; Gulhas N.; Koroglu A.The aim of this double-blind prospective randomized study was to investigate combination of low-dose (0.1 mg) intrathecal morphine and patient-controlled intravenous morphine in the management of postoperative pain following abdominal hysterectomy. Side-effects, satisfaction and sedation were also evaluated. Fifty patients (ASA I) between 30 and 65 years of age, scheduled for elective abdominal hysterectomy were randomized to receive intrathecal 0.1 mg of morphine sulfate (ITM) or placebo and intravenous morphine (IVM). Both groups received standard general anesthesia. In the ITM group, 0.1 mg morphine was administered intrathecally just before emergence from anesthesia while an equal volume of sterile saline was administered in the IVM group. Thereafter, all patients received IV morphine via a patient controlled analgesia (PCA) pump, set to deliver a bolus of 1 mg with a lock-out of 7 minutes and maximum dose of 20 mg per 4 hours. Hemodynamics, respiration, PCA demands, VAS, sedation scores, total morphine consumption, satisfaction and side effects were recorded for 24 hours after surgery. There were no significant differences between the groups with respect to satisfaction score. Total morphine consumption was lower in the ITM group; VAS scores at the first 8 hours were lower in the ITM group. Sedation scores at 4, 8, and 12th hours were higher in the ITM group. There was no significant difference in terms of adverse effects. In conclusion, intrathecal morphine (0.1 mg) combined with intravenous PCA is a safe and effective method of providing analgesia after hysterectomy as evidenced by lower pain scores and total morphine consumption and improved patient satisfaction.Öğe Comparison of cardiovascular effects and intubating conditions of cisatracurium and rocuronium in patients with coronary artery disease(2000) Torkoz A.; But A.K.; Koroglu A.; Durmus M.; Togal T.; Ersoy M.O.This study was designed to compare the cardiovascular effects and intubation condition of cisatracurium and rocuronium in cardiac surgical patients. Twenty patients scheduled for elective coronary artery bypass surgery were randomly assigned into two equal groups in a double blind fashion. Patients in group R (n=10) were given 0.9 mg/kg rocuronium and patients in group C (n=10) were given 0.15 mg/kg cisatracurium. Tracheal intubation was performed upon completion of maximum depression (% 100) in Train-of-four stimulation. Intubation conditions were rated according to Goldberg scale [1 (excellent) to 4 (intubation not possible)]. Heart rate (HR), systolic and diastolic arterial pressure SAP and DAP), central venous pressure (CVP), mean pulmonary artery pressure (PAPm), pulmonary artery wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), systemic and pulmonary vascular resistances (SVR and PVR) were measured invasively. Measurements were made before induction, 2 min after induction of anesthesia (basal), 1 min after after administration of muscle relaxant, at maximum depression in TOF and 2, 5, 10 min after intubation. Intubation condition were excellent in 60% of patients in the rocuronium group and in 90% of patients in the cisatracurium group, however there were no significant differences between the two groups (p>0.05). Rocuronium produced statistically significant increase in the heart rate at maximum depression in TOF, 2 min after intubation and in systolic blood pressure at 2 min after intubation (p<0.05). Other hemodynamic changes (DBP, CVP, CO, CI, PAPm, PAWP, SVR, PVR) were similar in the groups. As a result, induction with cisatracurium presented a more haemodynamically stable situation than rocuronium, but increases of cardiac rate and blood pressure with rocuronium were within clinically acceptable values.Öğe Effect of spinal anaesthesia level on the dosage of sedation(1999) Turkoz A.; Togal T.; Toprak H.I.; Ersoy O.It is sometimes observed that the patients under high spinal anaesthesia (T3-6) alter their wakefulness and that the patients become drowsy without sedative drugs. In these cases, the dosages of the sedative drugs should be decrease if the sedative drugs necessary. We have tested whether sensory level of T8 may affect the susceptibility to the soporific effect of sedatives. ASA grade I, 63 male patients undergoing elective lower extremity surgery were randomized to receive either spinal anaesthesia with sedation (group I), or general anesthesia with sedation (group 2). Patients in group 1 were given a subarachnoid injection of 3.5 mL hyperbaric bupivacine and those patients who had a sensory blockade level of T8 after 10 min. were divided in to three subgroups consisting ten patients (group 1a, 1b, 1c) and the patients in group II were also divided into three subgroups of ten patients (group IIa, IIb, IIc). Propofol, thiopenthone and midazolam were given until patients' sedation score achieve '3' and then stopped. In group Ia patients were given thiopenthone at the rate of 40 mg/kg/hr and in group 1c, the patients were given midazolam 1 mg intravenously, every 30 seconds. In group IIa, b, c infusion of drugs were started as stated above till the sedation score of '3' then general anaesthesia were induced. In group I and group II, the dose of propofol administered until the patients sedation score of '3' was achieved was 78±12.9 (group 1a), 83.8±11.1 mg (group IIa) p>0.05, the dose of thiopenthone was 147.5±35.4 mg (group 1b), 152.0±39.4 mg (group IIb) (p>0.05) and the dose of midazolam was 5.7±1.0 mg (group 1c), 6.4±2.2 mg (group II) (p>0.05). Although all three drugs were used less in group I than in group 2, no significant differences were observed between the groups statistically. In conclusion it is not required to reduce the amount of sedative drugs in the patients having a T8 level spinal anaesthesia.Öğe Evaluation by train of four vecuronium induced neuromuscular block during sevoflurane and isoflurane anaesthesia(1999) Togal T.; Gedik E.; Ersoy M.O.Volatile anaesthetics enhance the action of neuromuscular blockade to various degrees, the purpose of the present study is to compare the effects of volatile anaesthetics (isoflurane and sevoflurane) on the onset time of the neuromuscular blockade by vecuronium. Following approval from the ethic committee, 20 ASA I-II patients of either sex, aged 17-61 years old, were scheduled for elective laparoscopic surgery. Patients were randomly allocated to two groups. While induction of anaesthesia was performed with thiopentone 6 mg/kg and vecuronium 0.07 mg/kg, fentanyl 1 ?g/kg, lidocaine 1 mg/kg and maintained by 66/33 % N2O/O2 and sevoflurane (1.7 %) group I and isoflurane (1.2 %) in group II. The EMG response of the adductor pollicis was monitored by TOF-Guard stimulator (Biometer) at 20s intervals after train of four (TOF) stimulation of the ulnar nerve. Following intubation, whenever T1 returned to 25 % control additional doses of vecuronium was given (0.02 mg/kg). Supramaximal stimuli, duration 0.2 miliseconds and frequency 2 Hz were delivered at 20 seconds intervals to the ulnar nerve. The onset time (T1 max), duration of block (T1 25 %), time to maximal block after the second dose (T2 max), duration of action of maintenance doses (T2 25 %) and recovery times (T2 75 % - 25 %) were the parameters measured. There were no statistical significant differences between two volatile anaesthetics effects. In conclusion the effects of sevoflurane are similar to those of isoflurane on the neuromuscular block produced by vecuronium.Öğe Intensive care admission in patients with hellp syndrome in a tertiary referral hospital(SpringerOpen, 2015) Gedik E.; Yücel N.; Sahin T.; Koca E.; Çolak Y.Z.; Togal T.[No abstract available]Öğe Remifentanil and acute intermittent porphyria [4](Greenwich Medical Media Ltd, 2002) Durmus M.; Turkoz A.; Togal T.; Koroglu A.; Toprak H.I.; Ersoy M.O.[No abstract available]Öğe Retrospective analysis of intoxication patients admitted to intensive care unit: Evidence based management vs personal experience(2011) Ertan C.; Gedik E.; Yucel N.; Sinem Akgun F.; Aslan S.; Togal T.; Ozcan Ersoy M.Objective: Intoxication is a major problem in emergency departments (ED). Patients shall either be hospitalized or discharged after ED care. This decision requires a thorough evaluation of the patients' risk of mortality and cost effective approach. Aim of this study was to define characteristics of our poisoning patients and appropriateness of their hospitalization decisions to ICU. Methods: Adult patients hospitalized to ICU following admittance to ED within three years period with acute poisoning were retrospectively enrolled. Demographics, poisoning data, former psychiatric history, ICU follow up information, outcome at hospital discharge and in the first 28 days and predominant pathological clinical findings were recorded. Results: Our study group accounted for 3.6 per 1000 ED visits and 16.6% of ICU admittance. Mean age of the patients was 30.21±12.83 years, F/M ratio was 2.2 and 48.9% of the patients were married. Foremost encountered substances were psychoactive drugs (39.4%). 94.2% of our patients were suicidal and 39.8% of them used two or more agents. Intubation and mechanical ventilation was performed for 14 patients (5.1%), mean duration for intubated follow up was 7.07 days. Only two patients with caustic ingestions were dead (0.8%). Mean hospitalization period was 4.78±8.77 days and mean ICU bed use was 2.62±3.18 days. Total hospitalization duration was ?48 hours 198 (72.3%) patients and > 48 hours in 76 patients (27.7%). Conclusion: We speculate that, high rates of early discharge from ICU may support the necessity of a solid ICU admission criterion.
