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Öğe Anesthetic approach to adult moyamoya disease: A case report(Gulhane Askeri Tip Akademisi, 2010) Said Aydo?an M.; Yücel A.; Özgül U.; Öztürk E.; Konur H.; Namik Öztanir M.; Özcan Ersoy M.Moyamoya disease is an entity, which is caused by obstruction or stenosis in the area between the internal carotid artery, and anterior and middle cerebral arteries, identified angiographically, and does not have an exactly known etiology. The most frequent symptoms of onset are hemorrhage in adults and ischemia in children. In the treatment of moyamoya disease revascularization surgery is performed in order to decrease the vascular fragility. A specialized care is required in the perioperative period since surgery is often complicated by cerebral ischemia or cerebral hemorrhage. Aim in the perioperative anesthetic management is to provide the balance between oxygen supply to and use in the brain. In this case report we aimed to discuss the anesthetic management in a 22-year-old male patient with moyamoya disease in whom a multipl burr hole surgery was performed. © Gülhane Askeri Ti{dotless}p Akademisi 2010.Öğe Anesthetic management of a patient with sirenomelia: A case report(AVES, 2012) Yücel A.; Begeç Z.; Erdo?an M.A.; Konur H.; Ergin H.; Ersoy M.O.Sirenomelia or mermaid syndrome is an extremely rare developmental malformation characterized by complete or partial hipotrophy or fusion of the lower limbs. Gastrointestinal and urogenital anomalies are often accompanies with this congenital syndrome. Difficulty in determining the location of the peripheral veins and abnormal venous drainage may limit the use of limb for intravenous access. Associated anomalies should be identified and measures should be taken during the preoperative period. In this report we discussed anesthetic management of a patient diagnosed as sirenomelia syndrome.Öğe Anesthetic management of a patients with acute type A aortic dissection immediately after caesarean section(2012) Yücel A.; Gedik E.; Özgül Ü.; Erdo?an Kayhan G.; Koç E.; Erdil N.; Ersoy M.O.Acute aortic dissection is a disease which characterized by arterial wall separation, intimal dissection and hematoma. It has been seen half of dissections in women less than 40 yr of age occur during pregnancy, more commonly in the third trimester and postpartum period. Aortic dissection is a potentially risk factor for mother and baby during pregnancy. Ehlers-Danlos and Marfan's syndrome and number of pregnancy are associated with occurring of the aortic dissection. In this report, we discuss the management of anesthesia a patient with Marfanoid appearance who developed type A dissection of the aorta occurred 4 hours after elective Caeserean section.Öğe Anesthetic management of two patients with Cornelia de Lange syndrome(2012) Özgül Ü.; Begeç Z.; Yücel A.; Erdo?an M.A.; Bucak N.; Ersoy M.Ö.Cornelia de Lange syndrome is a rarely encountered disorder that is thought to progress secondary to hypoplasia of mesenchyma. Growth and mental retardation, hirsutism, major malformations of cardiac, gastrointestinal, and musculoskeletal systems with dysmorphic facial features are accompanied with this syndrome. Anesthetic management of these patients may encounter problems such as difficult tracheal intubation, aspiration and hypersensitivity to drugs. We want to review the anesthetic management and literature of the Cornelia de Lange Syndrome in this case presentation.Öğe Comparison of analgesic effects of intravenous dexketoprofen trometamol, lornoxicam and paracetamol on postoperative pain after total abdominal hysterectomy(AVES, 2011) Gülhaş N.; Durmuş M.; Yücel A.; Şahin T.; Erdil F.A.; Yolo?lu S.; Ersoy M.O.Objective: This study was intended to evaluate the analgesic efficacy of intravenously administered dexketoprofen trometamol in comparison with lornoxicam and paracetamol for acute postoperative pain. Material and Methods: 120 ASA physical status I-II patients undergoing total abdominal hysterectomy were enrolled in this study and randomly allocated into four groups (Groups D, L, P, and C). Following standard monitorization, in all groups, induction of anaesthesia was achieved via intravenous route using 5-7 mg kg-1 thiopental, 1 ?g kg-1 fentanyl, and 0.1 mg kg-1 vecuronium bromide, and also 6-8 % concentration of desflurane in 50 % O2 50 % N2O was used for the maintenance of anaesthesia in all groups. Patients received intravenous dexketoprofen trometamol 50 mg (Group D), 8 mg lornoxicam (Group L), 1 g paracetamol (Group P) and 100 mL SF (Group C) 30 min before the end of the surgery and 8-16 h after the surgery in Groups D, L, C. Group P received rescue medication at 6., 12., 18. and 24h after the surgery. At the end of the surgery, all patients received fentanyl via a patient controlled iv analgesia (PCA) device. Pain scores, cumulative fentanyl consumption, and patient satisfaction scores were assessed at 30 min, 2., 4., 6., 12. and 24h postoperatively. Results: The VAS scores at all evaluation time points, were similar among the groups. Fentanly consumption at 6., 12. and 24h postoperatively in Group P, L, and D was significantly lower when compared with Group C (p<0,05). Fentanyl consumption in Group L was lower relative to the other groups without any statistical significance. The patients' satisfaction scores at 6., 12. and 24h postoperatively in Group L were higher than the other groups (p<0,05). There was no significant difference between groups regarding sedation scores and side effects observed like postoperative nausea and vomiting and indigestion. Conclusion: We concluded that iv paracetamol, lornoxicam and dexketoprofen trometamol were equivalent in terms of analgesic efficiency in the management of postoperative pain after total abdominal hysterectomy.Öğe The effect of body-mass index on the duration of spinal anesthesia(AVES İbrahim KARA, 2006) Gülhaş N.; Begeç Z.; Durmuş M.; Erdem T.B.; Yücel A.; Ersoy M.Ö.Aim: The purpose of our study was to examine the duration of spinal anaesthesia obtained with same volume of local anesthetics in patients who have different bodymass index (BMI). Materials and Methods: After the approval from the faculty ethical committee and patient informed consent, 90 patient (ASA I-II, 15-65 years-old) who have undergoing elective urological surgery were included in to the study. Patients had normal body weight (BMI= 20-25), excessive body weight (BMI- 25-30) and obese patients (BMI= 30-35) were divided in N, EW (Excessive weight) and O groups, respectively. Spinal block was achieved by 3 mL hyperbaric bupivacaine with a 25 G Quincke spinal needle through L4-L5. Following the spinal block, maximum sensory block level, the periods to reaching the maximum sensory block, to decline of the sensory block at two levels, the time of the motor block relief were recorded in each patient in two minutes intervals. Results: The time to two level decline of sensory block and the time of the motor block relief were longer significantly in Group EW and O than Group N (p<0.05). Although motor block relief time was similar between group EW and O, there was a significant difference between these groups regarding to two level declining time (p<0.05). 2nd and 4 th minute Bromage scores were higher in Group O than Group N and Group EW (p<0.05) Conclusion: We considered that the duration of the spinal anaesthesia obtained with same volume of local anaesthetics were lengthened parallel to BMI.Öğe The effects of sevoflurane and propofol on hepatic and renal functions in elderly patients(2003) But A.K.; Durmuş M.; Köro?lu A.; Yücel A.; Ülger H.; Ersoy M.O.In this study, we aimed to compare the effects of sevoflurane and propofol on hepatic and renal functions in patients more than 65 years of age. 46 patients, ASA physical status I-II, more than 65 years of age, undergoing elective surgery were taken into the study. Anaesthesia was induced with 66% N2O and 7% sevoflurane in the group S (n=23) and iv.1-2 mg kg-1 propofol approximately within 30 seconds in the group P (n=23). Anesthesia was maintained with 1-4% sevoflurane and 66% N2O in group S, 2-10 m kg-1 hr1 propofol and 66% N2O in group P. Blood sample was taken from all patients preoperatively and postoperative 1, 3, 5-7 and 14.days to measure the total bilirubine (T.Bil.), aspartate aminotransferase (AST), g-glutamyl transferase (GGT), lactate dehydrogenase (LDH), alkalane phosphatase (ALP), creatinine (cre) and blood urea nitrogen (BUN). At the same time periods, creatinine clearences (K.Klr) were calculated, and protein and glucose qualitative analyses were done in urine. In Group S, AST and GGT at all postoperative periods, ALT and LDH in postoperatively 1 and 5-7th days, ALP and K.Klr in postoperatively 3rd day were measured significantly higher than preoperative basal values. In Group P, T.bil in postoperative 1st day, AST in postoperative 14th day, ALT and ALP at all postoperative periods, LDH in postoperative 1st and 3rd days were measured significantly higher than preoperative basal values. As a result; we concluded that sevoflurane and propofol anesthesia in ASA I-II elderly cases undergoing elective surgery, renal functions were preserved for both of the groups, but although there was no statistically significant difference between two groups, minimal transient hepatic dysfunctions were signifantly more in sevoflurane group.Öğe The Effects of Sevoflurane and Propofol on Induction, Maintenance and Recovery in Elderly Patients(2003) But A.K.; Durmuş M.; To?al T.; Gedik E.; Yücel A.; Özcan Ersoy M.In this study, we aimed to compare the effects of sevoflurane and propofol on induction, maintenance and recovery in elderly patients. Forty patients, ASA class I-II, more than 60 years of age, undergoing elective surgery that last between 2-4 hours were taken into the study. Anaesthesia was induced with 66 % N2O and 7 % sevoflurane in the group S (n=20) and 1-2 mg kg -1 propofol approximately within 30 seconds in the group P (n=20). In the two groups; loss of consciousness, loss of eyelid reflex, time to intubation, adverse effects during induction, heart rate (HR) and mean arterial pressure (MAP) after first, third and fifth minutes of induction were recorded. Maintenance of anaesthesia was provided with 66 % N2O and 1-4 % sevoflurane in group S, 2-10 mg kg -1 h-1 propofol and 66 % N2O in group P. HR and MAP values were determined after first minutes of intubation until the end of the operation. At the end of operation after discontinuation of anaesthetic agents, times to extubation, eye opening, verbal response, orientation and Aldrete score >8 were recorded. The only difference is that induction time was shorter significantly in the group P (p<0.05). Sevoflurane and propofol recovery times and postoperative complications were similar in ASA I-II, elderly cases undergoing elective surgery. Although its hypotensive effect was prominent, induction was faster with propofol. We concluded that both of sevoflurane and propofol can be used safely for ASA I-II elderly patients, if the dose of propofol decreased and given slowly.Öğe Öğe Induction of anaesthesia in coronary artery bypass graft surgery in elderly patients: Sevofluran-fentanyl versus midazolam-fentanyl(2006) But A.K.; Gedik E.; Yücel A.; Erdil F.; Nisano?lu V.; Durmuş M.; Ersoy M.Ö.We designed this study to compare the effects of sevoflurane-fentanyl and midazolam fentanyl during anesthetic induction in elderly patients in coronary artery bypass graft (CABG) surgery. Forty patients aged more than 65 years who underwent elective CABG surgery were included in this study. Anaesthesia was induced with sevoflurane 6% within 100% oxygen in Group S (n=20) and with midazolam, 0.2 mg kg-1, in Group M (n=20). Both techniques were supplemented by fentanyl, 5 ?g kg-1, and muscle relaxation was obtained with cis-atracurium, 0.1 mg kg-1. Time to loss of the consciousness, loss of eyelash reflex and intubation were recorded during induction in both of the groups. Heart rate and mean arterial blood pressure were recorded at baseline (T0), post-induction (T1), pre-intubation (T2), from the first minute with two-minute intervals for five minutes in post-intubation period (T3,T4,T5), post-incision (T6) and post-sternotomy (T7). Central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, systemic vascular resistance index, and pulmonary vascular resistance index were measured at T0, T1, T3, T6, and T7. Patient's satisfaction scores were obtained postoperatively. We concluded that inhalation induction with sevoflurane-fentanyl in elderly patients is fast, smooth and hemodynamically safe, similar to induction with intravenous agents in cardiac surgery.Öğe Protective effects of melatonin and ?-D-Glucan against liver injury in rats - A comparative study(Wroclaw University of Medicine, 2013) Aydogan M.S.; Erdogan M.A.; Polat A.; Yücel A.; Ozgül U.; Parlakpinar H.; Duran Z.R.Objectives. The aim of this study was to investigate the possible protective effects of melatonin and ?-D-glucan against ischemia-reperfusion (IR) injury in rats. Materials and Methods. Forty rats were randomly divided into 5 groups, each consisting of 8 animals, as follows. Sham group [S], IR group [C], IR + ?-Glucan group [?], IR + melatonin group [MLT], IR + melatonin + ?-Glucan group [MLT + ?]. The rats in the C, ?, MLT and MLT + ? groups were subjected to IR for 60 min each. Melatonin (10 mg·kg-1) was intraperitoneally injected for a single dose 30 min before IR. ?-Glucan (50 mg·kg-1·day -1) was orally administered for 10 days to rats. All of the rats were killed on day 11, and histological changes in the liver and tissue levels of oxidants and antioxidants were evaluated. Results. Malondialdehyde [MDA] level were significantly higher in the C group compared to the S group (p = 0.007). MDA level were significantly higher in the ? group compared to the MLT and MLT + ? groups (p =0.007). Tissue antioxidant markers (superoxide dismut ase [SOD], glutathione-peroxidase [GPx], and catalase [CAT]) were significantly lower in the C group than the S group (p < 0.05). SOD levels were simply not significant in the < group compared to the MLT and MLT + < groups. CAT and GPx activities were significantly higher in the ? group compared to the MLT and MLT + ? groups (p = 0.004).The histological damage ameliorated in ?, MLT and MLT + ? groups compared to C group. Conclusion. Our results suggest that melatonin and P-glucan combination pretreatment suppressed oxidative stress and increased antioxidant levels in an experimental rat model of liver IR injury. © Copyright by Wroclaw Medical University.Öğe Retrospective assessment of our anesthesia practice for electroconvulsive therapy(2008) Begeç Z.; Köro?lu A.; Gedik E.; Yücel A.; Toprak H.I.; Karlida? R.; Ersoy M.Ö.Aim: Electroconvulsive therapy (ECT) is a treatment method of some psychiatric disorders which is based on to form seizure activity by electrical stimulus. The aim of this retrospective study was to evaluate anesthetic agents which were used, the duration of seizure activity and recovery times, hemodynamic changes and the complications of the procedure in patients underwent ECT in our clinic. Materials and Methods: The anesthesia records of 460 ECT procedures performed in our clinic between October 2002-April 2007 were analyzed retrospectively. Patients were allocated to receive propofol 1 mg kg -1 after dexmedetomidine (1 ?g kg-1 h-1, 10 min.) premedication (Group 1); propofol 1,2 mg kg-1 (Group 2); propofol 1,5 mg kg-1 (Group 3); or sevoflurane 7 % (Group 4) without premedication as an induction agent. Results: Mean duration of motor seizure was 39.06±10.79 s. in Group 4, significantly longer than Group 1 and 3. Mean duration of motor seizure was 29.78±7.85 min in Group 3 significantly shorter than Group 2 (p<0.05). Duration of response to verbal stimulus in Group 3 and 4 were longer than Group 1 and 2 (p<0.05). Heart rate was lower in Group 1 compare from baseline value after convulsion at 1. and 10. min (p<0.05). Mean arterial pressure was lower at 10 min after convulsion in Group 1 and 3; at 1. and 10 min after convulsion in Group 4 (p<0.05). Conclusion: We determined that sevoflurane (7 %), 1,2-1,5 mg kg-1 dose of propofol and premedication with dexmedctomidine 1 ? kg-1 h-1 (10 min) prevent acute hemodynamic response to ECT without decreasing the duration of seizure. However, further studies of dexmedetomidine safety and interactions with other drugs are required before recommendation of its use for ECT procedures.Öğe An unusual localization of snake bite (case report)(AVES İbrahim KARA, 2006) Yücel A.; Gedik E.; Sürücü M.; To?al T.; Ersoy M.Ö.A case of nineteen years man who was bitten by a snake -genus viperidae- on the vertex of his head. It was a severe envenomation with ensuing marked edema with complicated coagulation defects. After medical treatment with antivenom and fresh frozen plasma the patient discharged without any complication.
