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Öğe Anaesthesia induction with ketamine:Propofol combination (ketofol) in caesarean delivery(2013) Kayhan G.E.; Toprak H.I.; Aslan A.; Çolak Y.Z.; Gülhaş N.; Durmuş M.; Ersoy M.Ö.Objective: The aim of this study was to compare the maternal and foetal effects of ketamine:propofol (ketofol) combination with thiopental, used in anaesthesia induction for caesarean delivery. Methods: Eighty, 18-35 years-old parturients in ASA I-II class, who were admitted for caesarean delivery under general anaesthesia, were allocated to this prospective, double-blind, randomised study. Patients were divided into two groups according to thiopental (Group T) or ketofol (Group K) administration. In anaesthesia induction, 4 mg kg-1 thiopental for Group T, 1 mg kg-1 ketamin + 1 mg kg-1 propofol (ketofol) for Group K were administered. Haemodynamic effects, BIS values, foetal parameters in the perioperative period and postoperative pain levels and morphine consumption were evaluated. Results: There were no significant differences between groups with regard to demographic data. Heart rate values were lower in Group K than Group T and there were significant differences between values immediately after intubation and 15 min after intubation. There were no significant differences in systolic and diastolic blood pressures between the two groups. Apgar scores recorded at the 5th minute were higher in Group K, while there were no differences in the 1st minute scores between groups (p=0.01). Upon analyses of umbilical artery blood gas, pH values were higher in Group K (p=0.034). While pain scores were similar in groups, total morphine consumption for 24 hours was found to be higher in Group K (p=0.008). Conclusion: We believe that 1 mg kg-1 ketofol (1:1), when used for anaesthesia induction of caesarean delivery, may be a good alternative to thiopental in terms of maternal and especially foetal effects; however, patients need to be followed closely for postoperative analgesic requirements. © 2013 by Turkish Anaesthesiology and Intensive Care Society.Öğe Anaesthetic management of a phaeochromocytoma patient with aortic valve insufficiency(2002) But A.K.; Durmuş M.; Gedik E.; Karaaslan K.; Toprak H.I.; Ersoy M.O.Phaeochromocytoma is an uncommon neuroectodermic tumour of adrenal medulla. Additional cardiac problems make anaesthesia management of phaeochromocytoma more complicated. We aimed to present the anaesthetic management of phaeochromocytoma patient with aortic valve insufficiency (AVI). A 45 years-old, 65 kg, female patient with third degree of AVI was admitted for phaeochromocytoma surgery. Before surgery, she was pre-treated with phenoxybenzamine and nicardipine for a week. In the operation room, thoracic epidural analgesia was maintained with 10 mL 0.5% bupivacaine loading dose, followed by 5 mL 0.5% bapivacaine for every hour during surgery. Then anaesthesia was induced with midazolam, droperidol, fentanyl, vecuronium, metoprolol and lidocaine. High dose fentanyl anaesthesia with 0.5-1.5% isoflurane were preferred for maintenance of anaesthesia. Haemodynamic stability was obtained with this anaesthesia management with lower dose vasodilators until the resection of adrenal mass. After the resection, severe hypotension was controlled with inotropic agents. Surgery was completed uneventfully and patient was transferred to ICU. In phaeochromocytoma cases with AVI, we think that appropriate anaesthetic approach is the thoracal epidural analgesia and high dose fentanyl anaesthesia with support of vasodilatators or vasoactive agents.Öğe Antibacterial effectiveness of alkalinized ropivacaine and bupivacaine(2007) Begeç Z.; Gülhaş N.; Toprak H.I.; Erdil F.; Yetkin G.; Özean Ersoy M.Aim: We aimed to investigate the antibacterial effects of alkalinized ropivacaine and bupivacaine on the Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa Materials and Methods: In this study, solutions of bupivacaine 0.5%, ropivaeaine 0.2%, bupivakain 0.5%+NaHCO3, ropivakain 0.2%+NaHCO3 with bactorial cultures' E. coli, S. aureus and P. aeruginosa were used. Bacteria were grown on standard blood agar. Bacterial cultures were prepared in a density of 0.5 McFarlands units (10 8 efu ml-1) with sterile saline 0.9% and each bacterial solution was further diluted in Mueller-Hinton broth to obtain standard inocula (105 cfu ml-1). The tested solutions (2 ml) and controls (2 ml, physiological saline) were added to 2 ml of standard bacterial preparations. Aliquats (3 ml) were vortexed and pipetted into sterile polystyrene spectrophotometer cuvets and it was incubated at 37°C. The optical density at 540 nm was measured at 0, 3 and 6 h by spectrophotometer. Results: While hupivacaine inhibited the growth of S. aureus and E. coli at all measurements times, P. aeruginosa inhibited at only 6 h (p<0.05). Alkalinized bupivacaine inhibited the growth of S. aureus at 0 h and E. coli at 0 and 6 h (p<0.05). Antibacterial effects of hupivacaine on E. coli was significantly higher than alkalinized bupivacaine at 6h (p<0.05). While ropivaeaine more inhibited the growth of S. aureus at 0 and 3 h than alkalinized ropivauaine, alkalinized ropivacaine less inhibited it according to the control (p<0.05). While both ropivacainc and alkalinized ropivakain inhibited the growth of E. coli at 3 and 6 h, at 0 h only ropivacaine inhibited it (p<0.05). Ropivacaine and alkalinized ropivaeaine inhibited the growth of P. aeruginosa at 3 h (p<0.05). Conclusion: It has been determined that bupivacaine has antibacterial effect and alkalinization of bupivacaine does not change it, ropivacaine has poor antibacterial effect and it more reduced with alkalinization of ropivacaine.Öğe Antioxidant effects of midazolam, isoflurane and desflurane during coronary artery by-pass grafting surgery(2009) Öztürk E.; But A.; Toprak H.I.; Demirbilek S.; Güleç M.; Ersoy M.Ö.It has been suggested that the reactive oxygen species (ROS) have essential role in the pathogenesis of myocardial ischemia-reperfusion injury. ROS may cause cardiac problems such as myocardial stunning, tissue damage and reperfusion cardiac arrhythmias may occur during weaning from pump in coronary artery bypass grafting (CABG). The aim of this study was compare the effects of midazolam, isoflurane, and desflurarie on the oxidative stress and hemodynamic parameters during CABG. After standard anesthesia induction, ninety patients were randomly allocated to Group M (midazolam), Group 1 (isoflurane), Group D (desflurane). Blood samples were obtained from the retrograde cannula placed in the coronary sinus; just prior to connecting to the pump (T1) and 5 minute after the cross-clamp removal (T2). In group M, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and adenosine deaminase (ADA) significantly increased, and nitric oxide (NO) and malondialdehyde (MDA) decreased at the T2 compared to the T1 (p<0.05). In Group 1, SOD and ADA increased at the T2 compared to the T1. While NO and MDA decreased, ADA increased in Group D at the T2 in comparison with the T1 (p<0.05). GSH-Px was significantly higher in Group M than Group 1 and D at the T2 (p<0.05). Although ADA was lower at the T2 in Group M than Group 1 and D, but there was only statistically significant difference between Group M and D (p<0.05). Midazolam had greater stimulating capacity on the endogenous antioxidant system and may caused less cellular damage than isoflurane and desjlurane due to its effects on the ADA.Öğe Application of prilocaine-lidocaine cream for the internal jugular venous cannulation and comparison with prilocaine HCI infiltration(2005) Köro?lu A.; Çiçek M.; But A.K.; Toprak H.I.; Ersoy M.Ö.In this study, it was aimed to evaluate the effects of prilocaine-lidocaine cream applied at different durations on the quality analgesia and procedure and to compare them with those of prilocaine HCI infiltration for internal jugular venous (IJV) cannulation. Seventy-five cases performing IJV cannulation before operations were included in the study. Prilocaine-lidocaine cream was applied before IJV cannulation in Groups I, II, III, and IV during 60, 90, 120 and 180 min, respectively. Prilocaine HCI infiltration was applied in cases of Group V. The level of pain was evaluated with the visual analogue scale during infiltration of prilocaine HCI and IJV cannulation. In addition, the depth of skin-İJV, the quality of analgesia and procedure were recorded. Adequate skin analgesia was obtained in all cases. Number of cases obtained adequate analgesia at different depths in cases in which prilocaine-lidocaine cream was applied were higher in Groups III and IV than in Groups I and II at 0.5 cm depth, higher in Group IV than in Groups I and II, and in Group III than in Group I at 1 cm depth, and higher in Group IV than in Group I at 1.5 cm depth. The quality of analgesia was better in group IV than in Groups I and II. Total number of cases obtained adequate analgesia was significantly higher, the requirement of additional 2% prilokain HCI infiltration was lower in Group IV than in Groups I and II, and also in Group V than in Groups I, II, and III, during IJV cannulation. As a result, we hold the opinion that prilocaine-lidocaine cream applied for 3 h provided more effective analgesia than the shorter duration of application. Also, since when it was applied during 90, 120, and 180 min it provided clinically better the quality of procedure it could be a better alternative to the prilocaine HCI infiltration.Öğe Arterial Myocardial Revascularization Using Bilateral Radial Artery: 17 Years after Right Pneumonectomy(2004) Erdil N.; Nisanoglu V.; Toprak H.I.; Erdil F.A.; Kuzucu A.; Battaloglu B.We report the case of a 51-year-old man who underwent arterial myocardial revascularization with the use of bilateral radial arteries, 17 years after undergoing a right pneumonectomy. We used a fast-track anesthesia protocol for the procedure. There was no perioperative complication, and postoperative recovery was uneventful. The patient was discharged from the hospital 5 days after the operation.Öğe Caudal block in paediatric surgery: A retrospective survey in 2262 patients(2005) Begeç Z.; Durmuş M.; Toprak H.I.; Köro?lu A.; Ülger H.; Ersoy M.Ö.; Özpolat Z.Aim: The caudal block is a common regional anaesthetic techniques in infant and children. Limited data regard complications have been reported. We reviewed the anaesthesia records of 2262 paediatric patients in whom caudal block was performed between June 1995-May 2004 in our institution and describe the associated morbidity and complications. Results: Anaesthesia was induced with inhalation agents in 1633 patients, and intravenous agents in 629 patients. Caudal blocks were obtained by administering 1 mL kg-1 of 0.25% bupivacaine in 1563 patients, 0.25% bupivacaine and 1% prilocaine in 400 patients, 0.25% bupivacaine and 0.5 mg kg-1 ketamine in 61 patients, 0.25% bupivacaine and 1 mg kg-1 fentanil in 106 patients, and 0.2% ropivacaine in 132 patients. Complications rates were not different between patients over 10 kg and ?10 kg. There were statistically significant differences regarding total complications, and subcutaneous infiltration and intravenous injection rates comparing 1-2 years residents with 2-3 years and 3-4 years residents and staff anaesthesiologists (p<0.05). Conclusion: We conclude that caudal block is an appropriate technique in paediatric patients scheduled for surgery below the umbilicus. Complication rates decrease after the first year of aneasthesia training.Öğe Comparison of haemodynamic profile and recovery characteristics of total intravenous anaesthesia and desflurane anaesthesia in paediatric outpatient surgery(2005) Özpolat Z.; To?al T.; Toprak H.I.; Öztürk E.; Çiçek M.; Ülger H.; Ersoy M.O.Aim: We aimed to compare the intraoperative haemodynamic profile and recovery characteristics of total intravenous anaesthesia (TIVA) with remifentanilpropofol and inhalation anaesthesia with desflurane-N2O in paediatric patients. Materials and Methods: Fifty children, ASA I, aged 4-12 years undergoing tonsillectomy, adenoidectomy or insertion of ventilation tubes, were included into the study. After premedication with midazolam orally, induction was performed intravenously with lidoeaine 1 mg kg-1, remifentanil 1 ?g kg-1, propofol 3 mg kg-1 and vecuronium 0.1 mg kg-1. Patients were divided into two groups: In Group I, remifentanil 0.5 ?g kg-1 min-1 and propofol 50 ug kg-1 min-1 were given; in Group II, desflurane 8.3 % and N2O 50 % in O2 were given. The heart rate (HR), mean arterial pressure (MAP), SpO2, PETCO2 and body temperature were monitorized. Emergence and recovery times, side effects like hypoxia, laryngospasm, nausea-vomiting, pain, and agitation were recorded. Results: In Group I, MAP increased at all times except after induction when compared with baseline, and decreased at all times except after intubation and surgical incision in Group II. HR decreased at surgical incision, 10, 20 and 30 minutes after incision in Group I when compared with baseline, and at all times except after intubation and surgical incision in Group II (p<0.05). In Group II, MAP was lower and HR was higher when compared with Group I. Eve-opening time and time to reach Aldrete score >8 in Group II was longer than in Group I. The time of spontaneous ventilation and extubation, and side effects were similar between groups. The incidence of postoperative pain and agitation was high in both groups. Conclusion: We concluded that both TIVA with propofol-remifentanil and desflurane-N2O based anaesthesia are suitable methods with short postoperative recovery for outpatient paediatric cases. However haemodynamic instability, postoperative agitation and pain are serious problems with both methods that should be solved.Öğe The comparison of hemodynamic effects of remifentanil or fentanyl addition to midazolam infusion for total intravenous anesthesia in coronary artery bypass surgery(2004) Köro?lu A.; Gedik E.; Gülhaş N.; Toprak H.I.; Karaaslan K.; Özcan Ersoy M.We aimed to determine the effects of remifentanil or fentanyl infusion with midazolam on response to endotracheal intubation, surgical stimulus and intraoperative hemodynamics in coronary artery bypass surgery. Anesthesia was induced with thiopental sodium 0.5-3 mg kg-1 and 2 ?g kg-1 remifentanil (Group R, n=31), or 15 ?g kg-1 fentanyl (Group F, n=29) in 60 cases included into the study. Anesthesia was maintained with 1 ?g kg-1 min-1 remifentanil in group R or 0.15 ?g kg-1 min-1 fentanyl in group F in addition to the midazolam infusion 0.15 mg kg-1 h-1. Mean arterial pressure (MAP), heart rate (HR) were recorded at 1, 3 and 5 min after intubation and surgical stimulus and 5 min intervals during surgery. Also time to intubation and complications were recorded. Heart rate was lower in group R after anesthesia induction. During opioid infusion both MAP and HR decreased more in group R than F. After skin incision, sternotomy and internal mamarian artery dissection MAP and HR were higher in group F than R. Hypertensive response to sternotomy, skin incision, internal mamarian artery dissection was less in group R than group F. Frequency of hypertension and requirement of nitroglycerin were lower in group R than group F during CPB. We concluded that thiopental sodium with remifentanil or fentanyl in anesthesia induction did not prevent the hypertensive response to intubation. However maintenance with remifentanil and midazolam infusion was more effective in preventing surgical stimuli.Öğe Comparison of thoracic epidural vs paravertebral patient controlled analgesia after donor hepatectomy(2012) Koç E.; Toprak H.I.; Aslan S.; Özgül Ü.; Kizilyel C.; Ersoy M.ÖObjective: We aimed to compare thoracic epidural vs paravertebral blockade in terms of the relief of postoperative pain in donor hepatectomy. Material and Methods: 50 patients, aged 18-60 years, ASA I-II undergoing donor hepatectomy operation were enrolled in this study. Patients were randomly allocated into two groups of 25 patients each (Group 1, paraver-tebral analgesia; and Group 2, epidural analgesia) and either paravertebral or epidural analgesia was applied at the level of T6-8. Postoperative VAS, vital signs, sedation score, overall patients' satisfaction, cumulative consumption of local anesthetic, rescue analgesic requirements and side effects were evaluated for 24 hours after surgery. Results: Cumulative local anesthetic consumption in Group 1 was higher when compared with Group 2 at 2 and 4 hrs after surgery (p<0.05). In Group 1, rescue analgesic requirement was higher than in Group 2, but the difference was not statistically significant. There was no difference in patient satisfaction between groups. There were no complications except for nausea and vomiting in one patient within each group. Conclusion: Paravertebral analgesia may be a good alternative to thoracic epidural analgesia for postoperative pain control in patients undergoing donor hepatectomy.Öğe The effect of intra-abdominal insufflation pressure on liver function in adult patients undergoing laparoscopic cholecystectomy(2005) Özpolat Z.; Durmuş M.; Toprak H.I.; Öztürk E.; Temel I.; Ersoy M.Ö.Aim: The relation between age and the effect of laparoscopic cholecystectomy on hepatocellular integrity has not been evaluated. We aimed to compare conventional liver function tests in two groups of adults of differing age undergoing elective laparoscopic cholecystectomy. Materials and Methods: We studied 43 patients divided into two groups according to age: Group 1, age 18-60 years (n=22) and Group 2, over 65 years (n=21). All patients received general anesthesia. CO2 was used to insufflate the peritoneal cavity, and intraperitoneal pressure was maintained at 10-14 mmHg during cholecystectomy. Reverse Trendelenburg position was maintained after CO2 insufflation. Arterial blood was sampled before the induction of anesthesia, at the end of surgery, and 1, 3, 6 and 24h after surgery for determination serum alanine aminotransferase (ALT) aspartate aminotransferase (AST), alpha-glutathione S-transferase (alpha-GST), and ganima-glutamyl transpeptidase (GGT) concentrations. Results: Baseline values of alpha-GST were within normal limits in both groups. Alpha-GST increased significantly in two groups at the end of surgery and at 1st hour after surgery. The increase of alpha-GST in Group 2 was higher than Group 1. Alpha-GST returned to normal values at 3,6 and 24h after surgery in both groups. Alpha-GST returned to the preoperative value at 24th h after surgery in Group 1 but not in Group 2. Conclusion: We conclude that elderly patients undergoing laparoscopic cholecystectomy have more hepatocellular injury when intraperitoneal pressure is greater than 10 mmHg.Öğe Effect of malnutrition on total intravenous anaesthesia in patients undergoing elective gastrointestinal surgery(2007) Çiçek M.; Turan Y.B.; Toprak H.I.; Köro?lu A.; Ersoy M.Ö.Aim: The effects of malnutrition on anesthesia induction, hemodynamics, recovery criteria, propofol consumption and complications were evaluated in patients undergoing elective gastrointestinal surgery. Material and method: Fifty adult patients (ASA I-III) were divided as well-nourished (n=24) and malnourished (n=26) after preanesthetic evaluation. For anesthesia induction, all patients recieved remifentanil (1 ?gr kg-1), 1 % propofol (until loss of consciousness and release of the object from the hand) and cisatracurium (0.1 mg kg-1). Patients were intubated 3 minutes afterwards. For maintenance, remifentanil 0.15 ?g kg-1 min -1, propofol 75 ?g kg-1 min-1 and cisatracurium 0.08 mg kg-1 h-1 were administered. Propofol dosage was adjusted according to hemodynamic changes. Age, weight loss in last 6 months, body weight, serum albumin level, intubation conditions, mean arterial pressure, heart rate, recovery criteria (spontaneous breathing, eye opening and extubation times), amount of propofol used and complications were recorded. Results: Mean age and weight loss were higher in malnourished patients when compared to well-nourished patients while body weight and albumin levels were lower (p<0.05). Mean arterial pressure at 20 and 30 minutes during the operation were higher in well-nourished patients (p<0.05). Heart rate was lower in well-nourished patients at 1 and 5 minutes during intubation and at 10 minutes during operation (p<0.05). The incidence of hypotension was higher in malnourished patients during anesthesia induction (p<0.05). Time to recovery of spontaneous breathing was shorter in well nourished patients (p<0.05), while eye opening and extubation times were similar. Conclusion: We propose that malnutrition might cause negative effects on blood pressure during anaesthesia induction. However, it does not alter intubation conditions, propofol consumption and recovery criteria.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 The effects of acute normovolemic hemodilution on postoperative cognitive functions in coronary artery bypass surgery(2003) Durmuş M.; Karaaslan K.; But A.K.; Toprak H.I.; Tekşan H.; Ersoy M.Ö.Moderate acute normovolemic hemodilution is tolerated well in most of cardiovascular surgery even in coronary artery bypass grafting (CABG). In this study we aimed to evaluate the effects of acute normovolemic hemodilution on postoperative cognitive functions in patients undergoing CABG surgery. After Ethics Committee approval, 62 patients undergoing coronary artery bypass surgery were studied. Patients were divided into hemodilution (Group H, n=31) and control (Group K, n=31) groups randomly. After induction of anesthesia, one or two units of blood were drawn from the Group H until the hematocrit values were lower than 35 %. At the same time, volume replacement was achieved with same amount of 6 % hydroxyethyl starch (HAES-steril 6 % (HES 200/0.5), Fresenius Kabi) infusion from peripheral vein. Any additional procedure was not performed in the Group K. Cognitive functions were evaluated with using "Wechsler Revised Memory Scale" one day before surgery, third day and at the end of first month after surgery. Both Forward and Reverse Digit Series and Figural Memory scores of Group H were higher than the control group at the postoperative third day and first month (p<0.05). Total scores of two groups were higher than the preoperative scores at the end of first month (p<0.05). It was concluded that acute normovolemic hemodilution during CABG surgery conserves postoperative attention and figural memory functions. Increased total scores in two groups at first month reflect the learning effects.Öğe Effects of dexmedetomidine and midazolam sedation on the haemodynamic response to epinephrine(Anestezi Dergisi, 2007) Erdil F.; But A.K.; Toprak H.I.; Öztürk E.; Ersoy M.Ö.Objective: The aim of our study is to evaluate the haemodynamic response of midazolam and dexmedetomidine sedation to local anaesthetic (LA) infiltration containing epinephrine and the analgesic effects and sedation during septoplasty operations. Methods: Dexmedetomidine (Group D; n:25) and midazolam (Group M; n:20) were given to patients as their sedation levels reached 3-4. The mean blood pressure (MBP), heart rate (HR), and visual analog scale (VAS) values were recorded preoperatively, after induction doses of sedation agents, after the infiltration of local anesthesia containing epinephrine and perioperatively. Postoperatively MBP and HR were recorded at 1, 2, 4, 6, 12, and 24 hours and the pain score of the patients was evaluated by VAS. Results: In group D, MBP after 10. minutes perioperatively, and HR after the dexmedetomidine induction, perioperatively at 20 and 30 minutes and postoperatively in the first hour were significantly lower when compared with the initial values (p<0.05). In group M, MBP after the induction and postoperatively at the 2nd hour was significantly lower when compared with the initial values, but HR was significantly increased after the induction, until the perioperative 30th minute (p<0.05). As for the evaluation of the groups: in group D, MBP till the perioperative 30th minute and postoperatively at 1, 4 and 24 hours, and HR between the end of induction and the perioperative 30th minute were significantly lower when compared with group M (p<0.05). Total diclophenac consumption was significantly lower and the time to the first analgesic requirement was also significantly longer in group D when compared with group M (p<0.05). Postoperative VAS values were significantly lower in group D when compared with group M. Conclusion: The results of our study showed that dexmedetomidine sedation could be preferred in septoplasty operations because of its beneficial effects on haemodynamic response after LA infiltration containing epinephrine and for its analgesic properties which is important in the postoperative period.Öğe The Effects of The Alfentanil and Remifentanil on Haemodynamic Variables and Postoperative Recovery at Gynaecologic Laparoscopy(2003) Toprak H.I.; Köro?lu A.; Gülhaş N.; To?al T.; Gedik E.; Aslan Ü.; Ersoy M.Ö.Anaesthetic and surgical developments increase the interest to outpatient surgery. Remifentanil, a short acting opioid, is a good alternative to alfentanil for outpatient surgery. We aimed to compare the effects of the alfentanil and remifentanil on haemodynamic variables, postoperative recovery and complication incidence during desflurane used at gynaecologic laparoscopic procedures. Fourty-two patients were included to the study after approval by local ethic committee. After anaesthesia induction was performed by 2 mg kg -1 propofol and 0.1 mg kg-1 vecuronium, the patients were randomly allocated into two groups. In alfentanil group (group A), alfentanil was received 15 ?g kg-1 bolus followed by 1 ?g kg dk -1 until incision and then continued 0.5 ?g kg dk-1. In remifentanil group (group R), remifentanil was received 1 ?g kg -1 bolus followed by 0.5 ?g kg dk-1 until incision and then continued 0.25 ?g kg dk-1. Anaesthesia was maintained with desflurane 3-5 % volume with 40 % oxygen in air. Mechanical ventilation was adjusted to achieve ETCO2 pressure of 35-40 mmHg. Mean arterial pressure (MAP), heart rate (HR) and SpO2 were recorded 10 min intervals during operation and 15 min intervals for postoperative 90 min period. End of the operation, the times of spontaneous ventilation, eye opening, extubation and orientation, and visual analogue scores (VAS), time for Aldrete score >8, first analgesic used and vomiting-nausea were recorded. There were no significant differences in recovery profiles and complications between two groups. All MAP values and HR at the time of 10th, 20th, 30th min, before and after extubation were significantly higher in group A than the other group. In group A, although MAP values were significantly higher at 40th min, before and after extubation, HR values were significantly lower at 20th, 30th, 40th and 50th min compared with baseline values. In group R, MAP values except 40th min and after extubation were lower compared with baseline values. HR values except after extubation were lower compared with baseline value. VAS was lower significantly at postoperative 15th min in group R. In conclusion, remifentanil is a better choice in gynaecologic laparoscopic procedures for haemodynamic stability in balanced anaesthesia than alfentanil. When remifentanil used, postoperative analgesia should be performed before the end of the operation.Öğe Glucose-insulin-potassium solution before cardiopulmonary bypass in coronary artery surgery(2000) Turkoz A.; Toprak H.I.; Sari S.; Ozturk E.; Durmus M.; Turkoz R.; Ersoy M.O.Glucose-insulin-potassium (GIK) solution has been advocated for the treatment of ischemic myocardium. This prospective, randomized clinical study was conducted to evaluate whether GIK solutions would cause benefit for the patients in addition to anterograd and retrograd combined blood cardioplegia undergoing coronary artery bypass grafting because of depressed left ventricle and unstable angina. The study group consisted of 33 patients with depressed left ventricle and unstable angina who underwent coronary artery bypass grafting, 2 patients were excluded from the study because of catheter dislocation. In 15 patients GIK solution (500 mL of 30 % dextrose, 70 units insuline, 80 mEq potassium) was given intravenously at 1 mL/kg per hour started with induction of anaesthesia, until the stage of cardiopulmonary bypass (CPB). Sixteen patients received ringer's lactate as the control group. The patients were analysed for hemodynamic changes, blood glucose and potassium levels. Pulmonary capillary wedge pressure, cardiac output, systemic vascular resistance, pulmonary vascular resistance were not different between two groups immediately before and after CPB. Blood glucose levels were not different between the two groups, but in both groups the levels increased after the end of the infusion of GIK solution, on the fifteenth minutes and at the end of the CPB. No differences were determined at the end of operation. There was no difference in serum potassium levels between the two groups, but potassium levels increased significantly during and immediately after CPB and decreased to the basal levels at the end of the operation in both groups. There was no significant difference between the groups in perioperative myocardial infarction, incidence of atrial and ventricular arrhythmias, times of ventilator support, length of stay in the intensive care unit and mortality. In this study, GIK therapy did not produce any additional positive hemodynamic effects and postoperative recovery from depressed left ventricle and urgent coronary artery bypass grafting.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.Öğe Hemodynamic, Hepatorenal and Postoperative Effects of Desflurane-Fentanyl and Midazolam-Fentanyl Anaesthesia in Coronary Artery Bypass Surgery(2004) But A.K.; Durmuş M.; Toprak H.I.; Öztürk E.; Demirbilek S.; Ersoy M.O.In this study, we aimed to compare the hemodynamic, hepatorenal and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anaesthesia during coronary artery bypass surgery. Sixty patients undergoing elective coronary artery bypass surgery with ejection fraction of more than 45% were included in the study. Patients were randomly divided into two groups as desflurane (Group D, n=30) and midazolam (Group M, n=30). Anaesthesia was induced with etomidate, 0.2 mg kg-1 and fentanyl, 5 ?g kg -1 in Group D and with midazolam, 0.1-0.3 mg kg-1 and fentanyl, 5 ?g kg-1 in Group M. For the maintenance of anaesthesia; desflurane, 2-6% and fentanyl, 15-25 ?g kg-1 were given in group D and infusion of midazolam at a rate of 0.1-0.5 mg kg -1 hr-1 and fentanyl at a rate of 15-25 ?g kg -1 were used in group M. Heart rate, mean arterial blood pressure, central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, left ventricle stroke work index and right ventricle stroke work index were measured before induction (t0), after induction (t1), after intubation (t2), after incision (t3), after sternotomy (t4), before cardiopulmonary bypass (t5), after protamine administration (t6) and at the end of the surgery (t7). Blood samples were taken to measure total bilirubine, aspartate amino transferase, gamma glutamyl transferase, lactate dehydrogenase, alkalane phosphatase, creatinine and blood urea nitrogen just before induction and at the 1st 4th and 14th days of postoperative period. In conclusion; intraoperative hemodynamic responses were similar in both of the groups and transient hepatic and renal dysfunction were observed in the postoperative period in both groups. The extubation and ICU discharge time were found to be shorter in the desflurane-fentanyl group.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]
