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    The combination of sevoflurane and thoracic epidural anesthesia without using muscle relaxant in patients with myasthenis gravis Undergoing thymectomy [Timektomi Uygulanacak Miyestenia Gravis Olgularinda Nöromüsküler Bloker Kullanilmaksizin Sevogluran ve Torasik Epidural Anestezi Kombinasyonu]
    (2003) Öztin Ö?ün C.; Duman A.; Sarkilar G.; Çelik J.B.; Ökesli S.; Aribaş O.
    In this prospective study, we combined induction with sevoflurane inhalation without neuromuscular blocking drugs, with thoracic epidural anesthesia for myasthenia gravis (MG) patients planed for transsternal thymectomy. We aimed to assess and present the procedure, respiratory and hemodynamic effects of this combination and our experiences during the intraopertative and postoperative periods. Inhalation induction with sevoflurane was performed in 7 MG patients with previous pulmonary function testing, following insertion of thoracic epidural catheters. Intubation was performed without neuromuscular blocker drugs. Sevoflurane and thoracic epidural analgesia were used together for maintenance. In all patients, arterial blood gases were monitored beside hemodynamic and respiratory parameters. End tidal sevoflurane concentrations which provides anesthetic depth was recorded. Continuous epidural analgesia was provided in the postoperative period in all patients. Paired t test, chi-square and Wilcoxon-match paired-tests were used for statistical analysis. All patients well tolerated induction with inhalation and intubation. The hemodynamic and respiratory parameters showed similar changes. The mean end tidal sevoflurane concentration of the patients for surgical anesthesia was 2.4±0.4 %. Postoperative pulmonary complications or respiratory depression were not encountered in any patient. As a conclusion, induction and maintenance with sevoflurane, combined with thoracic epidural anesthesia may be preferred in MG patients undergoing thymectomy. It was considered that, thoracic epidural anesthesia as a good choise for the stabilization of the postoperative period.
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    A comparison of the effects of intraoperative tramadol and ketamine usage for postoperative pain relief in patients undergoing tonsillectomy [I?ntraoperatif tramadol ve ketaminin tonsillektomi uygulanan hastalarda ameliyat sonrasi a?ri üzerine etkilerinin karşilaştinlmasi]
    (2013) Sizer C.; Kara I.; Topal A.; Çelik J.B.
    Objectives: We aimed to compare the effects of ketamine and tramadol administered intraoperatively on postoperative pain and analgesic demand in children undergoing tonsillectomy operations. Methods: Ninety children undergoing tonsillectomy, aging 5-15 years old, with ASA I - II, were included in this study. Cases were arranged in three groups and given standardized general anesthesia. After coagulation, ketamine (0.5 mg.kg-1) was administered intravenously (iv) in the ketamine group, and tramadol iv (2 mg.kg-1) was given in the tramadol group and the control group received a physiologic iv. The duration of anesthesia, duration of operation, and length of stay in the PACU were recorded. NRS and CHEOPS scales were used to assess postoperative pain. Paracetamol (15 mg.kg-1) was given rectally in the first 6 hours (hrs) and orally over the subsequent 6 hrs, if NRS greater than 3 and CHEOPS greater than 8 were observed. All data were recorded concerning the initial and total dosage of analgesic and the presence of complications within 24 hrs. Results: Demographic data, duration of anesthesia, duration of operation, and duration of stay in the PACU were similar between groups (p>0.05). The number of patients requiring additive analgesic was higher in the control group. No differences were found between the tramadol and ketamine groups (p>0.05). Additional analgesic was given earlier in the control group (p<0.05), but the need for additional analgesic was similar in tramadol and ketamine groups (p>0.05). Paracetamol dosage was significantly higher in the control group (p<0.05), but similar between the tramadol and ketamine groups (p>0.05). The frequency of nausea and vomiting was found to be significantly higher in tramadol and ketamine groups compared to the control group (p<0.05). Conclusion: Postoperative pain was effectively managed using 2 mg.kg-1 tramadol and 0.5 mg.kg-1 ketamine in pediatric tonsillectomies.