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Öğe Adeno-Tonsillektomi Operasyonu Geçiren Çocuklarda Farklı Anestezi İdamelerinin Postoperatif Bulantı ve Kusmaya Etkileri(2001) Öztin Öğün, Cemile; Duman, Ateş; Uysalel, AsumanGünübirlik adeno-tonsillektomi operasyonlarını geçiren yaşları 4-12 arasındaki 64 çocukta, anestezi idamesinde yer alan azot protoksit (Nsub2/subO) ile fentanilin postoperatif bulantı kusmadaki (POBK) rolü araştırıldı. Anestezi indüksiyonu tiyopental ve süksinilkolin ile yapıldı. Anestezi idamesinde çocuklar dört gruba ayrıldılar. Grup I (n16) %50 Nsub2/subO %50 Osub2/sub halotan (%1-1.5), Grup II (n16) %50 Nsub2/subO%50 Osub2/sub1 µg/kg/saat fentanil halotan (%1-1.5), Grup III (n16) %100 Osub2/sub1 µg/kg/saat fentanilhalotan (%1-1.5), Grup IV (n16) %100 Osub2/subhalotan (%1-2). Çocuklar postoperatif ilk 15 dakika, 15-60 dakika ve 60-240 dakikalarda POBK açısından gözlendiler. Gruplar arasında en sık POBK Grup I'de gözlendi (p0.05). Grup I' de en sık POBK görülen gözlem zamanı ise 15-60. dakikalar arasındaydı. Ayrıca anestezik rejime eklenen opioid (fentanil) POBK'yı artırmadı, hatta azot protoksit kullanılmayan opioidli grupta (grupIII) en düşük POBK gözlendi (p0.05). Sonuçta, düşük doz fentanilin intraoperatif kullanımının POBK nedenlerinden biri olan erken postoperatif ağrıya olumlu etkisi nedeniyle POBK'yı azaltabileceğini ancak Nsub2/subO'in adenotonsillektomi operasyonu geçiren çocuklarda POBK insidansını arttırdığı kanısındayız.Öğe Çocuklarda Mivakuryum ve Rokuronyumun Nöromusküler Blok ve Entübasyon Koşullarına Etkisi(2006) Apilioğulları, Seza; Ökesli, Selmin; Reisli, Ruhiye; Duman, Ateş; Öğün, Öztin CemileAmaç: Mivakuryum ve rokuronyumun sevofluran anestezisi altında adenotonsillektomi yapılacak çocuklarda nöromusküler bloğa ve entübasyon koşullarına etkilerini değerlendirmek amaçlandı. Yöntem: ASA I-II sınıfına giren, 2-12 yaş arasındaki 140 olgu Group M’de 0.2 mg/kg mivakuryum ve Group R’de 0.6 mg/kg rokuronyum uygulanmak üzere rasgele seçilmiş 2 gruba ayrıldı. Anestezi indüksiyonuna her iki grupta % 50 O2- % 50 N2O’den oluşan taze gaz akımına eklenen % 5 konsantrasyonda sevofluran ve 30 mcg/kg alfentanil ile başlandı. TOF-Guard ile T95, maksimal blok ve süresi, T25, T25-75, T70 parametreleri kaydedildi. Maksimal blok oluştuktan sonra entübe edilen ve entübasyon koşulları değerlendirilen hastalarda dekürarizasyon sadece rokuronyum grubunda uygulandı. Bulgular: T95 ve maksimal blok süresi Grup R'de istatistiksel olarak anlamlı derecede kısa iken grupların maksimal blok düzeyleri arasında anlamlı fark yoktu. T25 ve T70 süreleri Grup M'de, T25-75 süresi ise Grup R'de istatistiksel olarak anlamlı derecede kısa idi. Her iki grupta da mükemmel entübasyon koşulları saptandı. Sonuç: Her iki kas gevşeticinin de çocuklarda yeterli entübasyon koşullarını sağladığı, ancak rokuronyumun etki başlama süresinin kısa olması nedeniyle indüksiyonda ve acil durumlarda, mivakuryumun etki süresinin ve derlenme süresinin kısa olması nedeniyle kısa süreli operasyonlarda güvenle kullanılabileceği kanısına varıldı.Öğe Çocuklarda Spinal Anestezi: Tek Merkezin 371 Olguluk Deneyimi(2010) Apilioğulları, Seza; Gök, Funda; Duman, AteşAmaç: Çocuklarda spinal anestezi (SA), rutin cerrahi prosedürlerden daha çok, kompleks olgularda kullanımı kabul edilmiş gibi görünmektedir. Ancak, çocuklarda SA kullanımı yetişkinlerde olduğu gibi basit, güvenli ve ekonomiktir. Bu çalışmanın amacı, çocuklarda rutin cerrahi işlemlerde spinal anestezinin etkinliği ve güvenliği ile ilgili deneyimlerimizi sunmaktır. Gereç ve Yöntem: Konya Dr. Faruk Sükan Doğum ve Çocuk Hastanesi’nde, 2007-2009 yılları arasında spinal anestezi altında ameliyat edilen 371 hastanın dosya bilgileri geriye dönük olarak incelendi. SA uygulamaları hiperbarik bupivakain kullanılarak, 27 G kalem uçlu iğne ya da 26 G keskin uçlu iğne ile gerçekleştirilmişti. Bupivakaine adjuvan olarak fentanil 0,2 ?g kg-1 ya da morfin 2 ?g kg-1 ya da her ikisi birlikte kullanılmıştı. Kayıtlardaki kişisel veriler, teknik veriler ve yan etkiler değerlendirildi. Bulgular: Hastaların yaş ortalaması 6 (1-17 yaş) idi. Hastaların % 94’ünde ilk girişimde olmak üzere başarılı SA sağlandığı saptandı. Çocukların % 26’sında operasyon sırasında ek intravenöz sedasyon gerekmişti. On hastada (% 2,7) operasyon sırasında genel anesteziye geçilmesi gerekmişti. Adjuvan olarak, 134 hastada fentanil, 50 hastada morfin, 40 hastada fentanil ve morfin birlikte kullanılmıştı. Başlıca yan etki; 3 hastada görülen bradikardi ve hipotansiyonun olmadığı yüksek düzeyde spinal bloktu (% 0,8). Ciddi nörolojik ve kardiyovasküler yan etkilere rastlanmadı. Sonuç: Hiperbarik bupivakain ile gerçekleştirilen spinal anestezi uygulamasının, uygun endikasyonu olan çocuklarda güvenilir ve kolay uygulanabilir bir anestezi yöntemi olduğu değerlendirildi. Çocuklarda intratekal 0,2 ?g kg-1 fentanil ve 2 ?g kg-1 morfin dozlarını kullanmanın uygun olduğu kanısına varıldı.Öğe Comparison of 50 ?g and 25 ?g Doses of Intrathecal Morphine on Postoperative Analgesic Requirements in Patients Undergoing Transurethral Resection of the Prostate With Intrathecal Anesthesia(Elsevier Science Inc, 2010) Duman, Ateş; Apilioğulları, Seza; Balasar, Mehmet; Gürbüz, Recai; Karcıoğlu, MuratStudy Objective: To compare the efficacy of 50 mu g and 25 mu g closes of intrathecal morphine on postoperative pain in patients undergoing transurethral resection of the prostate (TURP) with low-close bupivacaine Design: Randomized, double-blinded study Setting: Konya Hospital Patients: 70 ASA physical status I. II, and III patients Interventions: Patients were randomized to two groups Group A patients received 5 mg of 0.5% hyperbaric bupivacaine (one mL) and 50 mu g of morphine (0 5 mL) Group B patients received 5 mg of 0.5% hyperbaric bupivacaine (one mL) and 25 mu g of morphine (0 5 mL) Measurements: Postoperative pain scores, patient and surgeon satisfaction, and side effects such as emesis, pruritus, and respiratory depression, were recorded. Main Results: Postoperative pain characteristics were similar between the two groups Frequency of emesis was similar between the groups, while pruritus was significantly higher in Group A No antipruritic medication was required in any patient Patient and surgeon satisfaction was evaluated as good or excellent in both groups. Conclusions: Intrathecal morphine at a dose of 25 mu g provides similar postoperative analgesia and less pruritus than the 50 mu g dose in patients undergoing TURP.Öğe Comparison of Intrathecal Isobaric Bupivacaine-Morphine and Ropivacaine-Morphine for Caesarean Delivery(Elsevier Sci Ltd, 2003) Öğün, Cemile Öztin; Kırgız, E. N.; Duman, Ateş; Ökeşli, Selmin; Akyürek, CemalettinBackground. This study was designed to evaluate the effects of intrathecal isobaric bupivacaine 0.5% plus morphine and isobaric ropivacaine 0.5% plus morphine combinations in women undergoing Caesarean deliveries. Method. Twenty-five parturients received ropivacaine 15 mg and morphine 150 mug (RM group) and twenty-five parturients received bupivacaine 15 mg and morphine 150 mug (BM group) for spinal anaesthesia. Sensory and motor block, haemodynamics, postoperative analgesia, fetal outcomes, and side-effects were evaluated. Results. Intrathecal bupivacaine-morphine and ropivacaine-morphine provided effective sensory anaesthesia and motor block. Time to reach complete motor block was shorter and time to complete recovery from motor block was longer in the BM group than the RM group (P<0.05). The time to regression of two dermatomes and time for the block to recede to the S2 dermatome were similar in both groups (P>0.05). Time to first complaint of pain and the mean total consumption of tenoxicam were similar in both groups (P>0.05). APGAR scores at 1 and 5 min were similar in the two groups, as were mean umbilical blood pH values (P>0.05). Hypotension and pruritus were the most common side-effects in both groups during the operation. Conclusion. Intrathecal isobaric ropivacaine 0.5% 15 mg plus morphine 150 mug provides sufficient anaesthesia for Caesarean delivery. The ropivacaine-morphine combination resulted in shorter motor block, similar sensory and postoperative analgesia.Öğe Correlation Between Tissue Lactate Levels and Electroencephalogram In Evaluating the Severity of Experimental Head Trauma(Lippincott Williams & Wilkins, 2002) Öğün, Cemile Öztin; Üstün, Mehmet Erkan; Duman, Ateş; Gürbilek, Mehmet; Genç, Bülent OğuzObjective: The objective of this study was to develop an electroencephalographic grading scale for evaluating the severity of head trauma and assessing the correlation of this scale with brain tissue lactate concentrations. Design: Animal experiment. Setting: Animal research laboratory in a university hospital. Subjects: Thirty New Zealand rabbits were divided into three groups. Interventions: Rabbits were anesthetized, and bilateral frontoparietal craniectomy was performed. An electroencephalogram was recorded over the dura from both sides. After electroencephalographic recording, unilateral trauma was produced by using the weight drop method with a calculated force of 401) g(.)cm(-1) and 800 g(.)cm(-1) in group 2 (n = 10) and group 3 (n = 10), whereas in group I (n = 10) only craniectomy was performed. Electroencephalographic recording was repeated 60 mins after trauma or craniectomy, and cortical tissue samples were resected from both sides to evaluate tissue lactate concentrations in all three groups. Measurements and Main Results: Electroencephalographic recordings from both sides of the brain were evaluated together by using a 6-point scale (1 = best to 6 = worst) that was based on the presence or absence of electroencephalographic activity and the decrease in amplitude or frequency band of the electroencephalogram. Lactate was measured in resected tissue by using spectrophotometric enzymatic methods. One-way analysis of variance for repeated measures, Bonferroni-adjusted paired Student's t-test, Kruskal Wallis analysis of variance, Bonferroni-adjusted Mann-Whitney-U, and Spearman's correlation tests were used as appropriate for statistical analysis. We considered p < .05 to be significant. The difference in lactate concentrations was significant between the three groups (p < .05). Electroencephalographic grades were significantly different between the pretraumatic and posttraumatic recordings (p < .05) and between the three groups after craniectomy or trauma (p < .001). There was a positive high correlation between lactate concentrations and electroencephalographic grades. Conclusions. Tissue lactate concentrations and electroencephalograhic grades change with the severity of the trauma, and there is a strong positive correlation between tissue lactate concentrations and electroencephalographic grades.Öğe Cost analysis in intensive care units of a university hospital(CUKUROVA UNIV, FAC MEDICINE, 2019) Kara, İskender; Kara, İnci; Bayraktar, Yeşim Şerife; Çicekçi, Faruk; Yılmaz, Hüseyin; Duman, Ateş; Çelik, Jale BengiPurpose: Intensive care units have an important place among the units of hospitals with high cost problems. In order to ensure the quality and continuity of the service provided in these units, hospitals should perform cost analysis in certain periods. In this study, we aimed to present some general characteristics and income-expense conditions of intensive care units in our third level hospital. Materials and Methods: Demographic data, features of intensive care units and income-expenditure status of 5722 patients who stayed in 11 intensive care units between May 2017 and May 2018 were recorded and compared. Expenses for intensive care units were calculated by grouping as first, second and third parts. Results: Cardiology, internal diseases, pediatric diseases, neurosurgery and anesthesia intensive care units had higher occupancy rates. Mean duration of intensive care unit hospitalization was higher in pediatric diseases, newborn, anesthesia and neurology intensive care units. Mortality rates were found to be the lowest in neonatal and cardiology intensive care units, while the highest rate was found in pulmonary diseases intensive care unit (1%, 4.5% and 51.2%, respectively). After the income was calculated according to the intensive care unit levels, the difference between the incomes and expenses was found. Total expenses of intensive care units amounted to TL 30.498.563,49, while income was TL 30.555.040,35. A difference of TL 56.476,86 was obtained. Conclusion: Intensive care payments based on the level system by the Social Insurance Institution were found to be sufficient for the costs of the hospitals in this area.Öğe Delayed Recovery From Rocuronium Block in an Infant(2012) Kara, İnci; Duman, İpek; Duman, AteşProlonged duration of action of rocuronium in an infant patient is rare. We report an unusual case of prolonged neuromuscular blockade with rocuronium in an infant undergoing cleft lip repair anesthetized with sevoflurane and management of the patient.Öğe Effect of Cooling on the Responses of Human Saphenous Vein to Fentanyl, Remifentanil and Sufentanil(Blackwell Publishing, 2006) Şahin, Ayşe Saide; Duman, Ateş; Günaydın, İshak Gürsel; Şahin, Tahir Kemal; Görmüş, Niyazi; Duman, İpekWe studied the vasodilatory effects of fentanyl, remifentanil and sufentanil on the human saphenous vein strips at 37, 32 and 28 degrees C. Fentanyl produced concentration-dependent relaxation of human saphenous vein strips precontracted with 5-hydroxytryptamine (5-HT) at every temperature studied. Compared with vein strips at 37 degrees C, relaxant responses to each one concentration of fentanyl were significantly reduced at 32 and 28 degrees C. Remifentanil relaxed vein strips in a concentration-dependent way and the relaxation for all concentrations were significantly greater at 32 and 28 degrees C compared with 37 degrees C. Sufentanil produced concentration-dependent relaxation in saphenous vein strips precontracted with 5-HT. These relaxant responses were similar at 32 degrees C compared with 37 degrees C. When bath temperature was lowered from 37 to 28 degrees C, the relaxant responses to sufentanil were significantly reduced. In summary, the present study suggests that cooling reduces the relaxation caused by fentanyl and sufentanil on human saphenous veins but augments the relaxation with remifentanil. The augmented vasodilatory effect of remifentanil with cooling may be useful on systemic vascular resistance and organ preservation under hypothermic conditions like cardiopulmonary bypass surgery.Öğe The Effect on Intraocular Pressure of Tracheal Intubation or Laryngeal Mask (Tm) Insertion During Sevoflurane Anaesthesia in Children Without the Use of Muscle Relaxants(BLACKWELL SCIENCE LTD, 2001) Duman, Ateş; Öğün, Cemile Öztin; Ökeşli, SelminBackground: We studied the effects of sevoflurane on intraocular pressure after induction in children undergoing either tracheal tube (TT) or laryngeal mask airway (LMA(TM)) insertion without a muscle relaxant Methods: The study included 38 children. Anaesthesia was induced (8%) and maintained (3-4%) with sevoflurane in 100% O-2. NO muscle relaxant was used. A TT was inserted in group I (n = 20), and an LMA in group II (n = 18). IOPs were measured after induction, insertion of TT or LMA and at 1, 2 and 3 min thereafter. The heart rate, mean arterial pressures were also recorded. Results: Intraocular pressures increased significantly in group I after TT (P < 0.01) and remained high until after 3 min. The pressures were similar in the LMA group at all measurements. Conclusions: Sevoflurane does not prevent the increase in IOP after intubation without muscle relaxants. LMA does not increase IOP in children after sevoflurane induction.Öğe The effects of 45 degree head up tilt on the lumbar puncture success rate in children undergoing spinal anesthesia(WILEY-BLACKWELL, 2008) Apılıoğulları, Seza; Duman, Ateş; Gök, Funda; Ogun, Cemile Öztin; Akıllıoğlu, İshakBackground: There are few studies for procedural techniques of lumbar puncture (LP) for spinal anesthesia in children. There are no controlled studies on the effect of patient positioning. We designed this prospective, randomized study to compare the success rates of LP of the lateral decubitus and lateral decubitus position with a 45 degree head up tilt in children undergoing spinal anesthesia. Methods: Study was conducted in 180 children aged between one month to twelve years. The LP was performed under general anesthesia using sevoflurane with a 26-gauge, atraumatic needle either in the standard lateral decubitus, knee-chest position (group I, n = 90) or lateral decubitus, knee-chest position with a 45 degree head up tilt (group II, n = 90). The free flow of clear cerebrospinal fluid (CSF) at first attempt was considered to evidence a successful LP. Results: The two groups were similar in age and weight. Total LP success rate was higher in group II than in group I (P < 0.05). When the significance between the groups was evaluated according to age, the increase in LP success rate was significant in children aged < 12 months of age but not significant in children older than 12 months of age. Conclusions: Because of higher success rate, lateral decubitus, knee-chest position with 45 degree head up tilt may be the preferred position for spinal anesthesia in infants.Öğe Effects of Deferoxamine on Tissue Superoxide Dismutase and Glutathione Peroxidase Levels in Experimental Head Trauma(LIPPINCOTT WILLIAMS & WILKINS, 2001) Üstün, Mehmet Erkan; Duman, Ateş; Öğün, Cemile Öztin; Sümer, Fatih; Gürbilek, MehmetBackground: This study aims to evaluate the effects of deferoxamine on tissue superoxide dismutase (SOD) and glutathione peroxidase (GPx) brain levels after head trauma. Methods: Thirty rabbits were divided equally into three groups: group 1 was the sham-operated group, group 2 suffered head trauma (no treatment was given), and group 3 received deferoxamine 50 mg/kg after the trauma. Head trauma was applied unilaterally. One hour after trauma, brain cortices were resected and SOD and GPx levels were determined. One-way analysis of variance and Tukey-HSD tests were used for analysis. Significance was defined asp < 0.05. Results: Baseline SOD levels are preserved in the traumatized side of the deferoxamine-treated group. Although GPx level of the traumatized side of the deferoxamine-treated group decreased significantly, the decrease was significantly less than the nontreated group. Conclusion: Trauma leads to a decrease in brain tissue SOD and GPx levels, Deferoxamine suppresses this decrease completely in SOD level and partially in GPx level when given after trauma.Öğe Effects of Intrathecal Fentanyl on Quality of Spinal Anesthesia in Children Undergoing Inguinal Hernia Repair(Wiley-Blackwell, 2010) Duman, Ateş; Apilioğulları, Seza; Duman, İpekBackground: The effect of intrathecal fentanyl on the characteristics of spinal anesthesia has not been investigated in children undergoing inguinal hernia repair. The purpose of this study was to assess whether the incidence and severity of pain during peritoneal sac traction is decreased by addition of fentanyl to bupivacaine in children undergoing inguinal hernia repair with spinal anesthesia. Methods: Children (6-14 years) were randomized into two groups. Group F (n = 25): hyperbaric bupivacaine plus 0.2 mu g.kg(-1) of fentanyl. Group P (n = 25): hyperbaric bupivacaine plus 0.9% NaCl (placebo). The dose of bupivacaine was 0.4 mg.kg(-1). The primary variable was the incidence and severity of pain during peritoneal sac traction. Spinal block characteristics, duration of spinal anesthesia assessed by recovery of hip flexion and duration of analgesia were the secondary variables measured, and the side effects were noted. Results: There were significant differences in incidence of pain and pain scores during sac traction with lower incidence and scores in the fentanyl group (P = 0.009). Two groups were similar regarding the level of sensory block during sac traction and duration of spinal anesthesia. Duration of spinal analgesia was prolonged significantly in the fentanyl group (P = 0.025). Conclusion: Intrathecal fentanyl at a dose of 0.2 mu g.kg(-1) added to bupivacaine significantly improves the quality of intraoperative analgesia and prolongs postoperative analgesia in children undergoing inguinal hernia repair with spinal anesthesia.Öğe Effects of Magnesium Sulfate on Tissue Lactate and Malondialdehyde Levels in Experimental Head Trauma(SPRINGER-VERLAG, 2001) Üstün, Mehmet Erkan; Gürbilek, Mehmet; Ak, Ahmet; Vatansev, Hüsamettin; Duman, AteşObjective: To determine the effects of magnesium sulfate (MgSO4) on tissue lactate and malondialdehyde (MDA) levels in rabbit brain after experimental head trauma. Design: Prospective, randomized trial. Subjects: Thirty New Zealand rabbits. Interventions: Group 1 (n = 10) was the sham operated group. Group 2 (n = 10) (untreated group) and group 3 (n = 10) received head trauma with the weight drop method. MgSO4 was administered 100 mg/kg (15%) i.v. immediately after the head trauma to group 3. Trauma was applied to one side. The non-contused side was named as "a" and the contused side as "b". Measurements: One hour after trauma, brain cortices were resected and the concentrations of lactate and MDA were determined using the spectrophotometric enzymatic and thiobarbituric acid methods. One-way ANOVA and Tukey's HSD tests were used for the evaluation of the results. P < 0.05 was considered as significant. Pearson's correlation test was used between lactate and MDA levels (P < 0.001). Results: There were significant differences between MDA and lactate levels of group 1 and all other groups; non-contused (a) and contused (b) sides of groups 2 and 3; groups 2b-3a, 2b-3b (P < 0.05). The difference in MDA levels was significant between groups 2a-3b (P < 0.05). Correlation between lactate and MDA was very good in group 1, and excellent in groups 2a, 2b, 3a, and 3b. Conclusions: These results demonstrate that head trauma leads to an increase in brain tissue lactate and MDA levels, and MgSO4 suppresses the rise in contused tissue when given after head trauma.Öğe Effects of Nimodipine and Magnesium Sulfate on Endogenous Antioxidant Levels in Brain Tissue After Experimental Head Trauma(LIPPINCOTT WILLIAMS & WILKINS, 2001) Üstün, Mehmet Erkan; Duman, Ateş; Öğün, Cemile Öztin; Vatansev, Hüsamettin; Ak, AhmetTo examine the effects of calcium antagonists nimodipine and magnesium sulfate (MgSO4) on tissue endogenous antioxidant levels, the authors studied superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels in rabbit brain 1 hour after experimental head trauma. Forty New Zealand rabbits were anesthetized and randomly divided into four groups. Group 1 (n = 10) was the sham operated group. Group 2 (n = 10), the control group, received head trauma and no treatment. Group 3 (n = 10) received head trauma and intravenous (IV) 2 mu gr/kg nimodipine. Group 4 (n = 10) received head trauma and IV 100 mg/kg MgSO4. Head trauma was delivered by performing a craniectomy over the right hemisphere and dropping a weight of 20 g from a height of 40 cm. In the right (traumatized) hemisphere, SOD and GPx decreased by 57.60% +/- 9.60% and 72.93% +/- 5.51% respectively from sham values. Magnesium sulfate, but not nimodipine, reduced the magnitude of decrease of SOD and GPx to 19.43% +/- 7.15% and 39.01% +/- 7.92% respectively from sham values. In the left (nontraumatized) hemisphere, MgSO4 increased SOD to 42.43% +/- 24.76% above sham values. The authors conclude that MgSO4 treatment inhibited the decrease in SOD and GPx levels in experimental brain injury.Öğe Efficacy of a low-dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair(WILEY-BLACKWELL PUBLISHING, INC, 2009) Apılıoğulları, Seza; Duman, Ateş; Gök, Funda; Akıllıoğlu, İshak; Çiftçi, İlhanP>Background: Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double-blinded, randomized, and placebo-controlled study to compare the efficacy of a low-dose (2 mu g center dot kg-1) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia. Methods: Fifty-four children were randomly assigned to one of two spinal anesthesia groups. Group M (n = 27) received hyperbaric bupivacaine plus 2 mu g center dot kg-1 of preservative-free morphine and group P (n = 27) received hyperbaric bupivacaine plus 0.9% NaCl (placebo) under inhalation anesthesia. General anesthetics were discontinued subsequent to the block. The primary outcome was the presence of pain-requiring analgesics during the first 12 h after the spinal block. Side effects were also recorded. The analgesic effects were evaluated by using the Children's Hospital of Eastern Ontario Pain Scale. Results: Forty-nine patients completed the trial. Fifteen patients (60%) in group P received supplementary analgesics within the first 12 h compared to only four patients (16.7%) in group M (P = 0.005). Mean duration of analgesia was 480 +/- 209 and 720 +/- 190 min in group P and group M respectively (P = 0.009). The groups were similar in postoperative side effects. Conclusion: Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 mu g center dot kg-1 intrathecal morphine provides better postoperative pain control when compared to placebo in these children.Öğe Epidural anestezide bupivakain-tramadol kombinasyonunun bupivakain-fentanil ve bupivakain ile karşılaştırılması(2002) Kesriklioğlu, Abidin; Duman, Ateş; Öğün, Öztin Cemile; Reisli, Ruhiye; Ökesli, SelminBu çalışmada, epidural anestezide kullanılan %0.5 bupivakain ve tramadol kombinasyonu, fentanil-bupivakain veya yalnızca bupivakain ile, epidural anestezi özellikleri, hemodinamik, solunumsal ve yan etkiler açısından karşılaştırıldı. Bu amaçla transüretral prostat rezeksiyonu uygulanacak 63 olgu 3 gruba ayrıldı. Epidural kateter yoluyla; Grup BT'ye (n22) 70mg (14ml) %0.5 bupivakain50 mg tramadol, Grup BF'ye (n21) 70mg (14ml) %0.5 bupivakain50 mugfentanil ve Grup B'ye (n20) tek başma70mg (14ml) %0.5'lik bupivakain uygulandı. Tüm gruplarda, kalp atım hızı (KAH), ortalama arter basınçları (OAB), solunum sayısı ve Sp02, duyusal blok düzeyi, maksimum duyusal blok düzeyi ve motor blok dereceleri gözlenerek kaydedildi. Postoperatif dönemde etkin analjezi süresi (VAS 4'e ulaşma zamanı) ve yan etkiler kaydedildi, istatis-tiksel değerlendirmede tek yönlü varyans analizi (ANOVA), Tukey HSD analizi, Kruskall Wallis ve Bonferroni düzeltmeli Mann-Whitney U testi kullanıldı ve p0.05 anlamlı olarak kabul edildi. Epidural blok sonrası, üç grup arasında da KAH'larında anlamlı bir değişiklik olmadı. Fentanil-bupivakain grubunda diğer gruplardan farklı olarak, OAB'da blok sonrası 40. dakikada başlayan ve 60. dakikaya kadar süren anlamlı bir düşme oldu. Duyusal bloğun T 10'a ulaşma süresi ile, en üst dermatoma ulaşma süreleri Grup BF' de Grup BT ve B'den daha kısa iken, Grup BT ve B'de bu süreler benzerdi. Tam motor blok gelişme süreleri ve tam motor blok gelişen olgu sayıları Grup BT ve BF'de benzerdi. Grup B'de hiçbir olguda tam motor blok gelişmedi. VAS 4'e ulaşma süresi tüm gruplarda anlamlı olarak farklıydı (p0.05). VAS 4'e ulaşma süresi; Grup BT'de 17.577.82 saat, Grup BF'de 11.798.48 saat ve Grup B'te 5.402.67 saat olarak ölçüldü. Her üç grupta da yan etkiler benzerdi ve tedavi gerektirmedi. Sonuç olarak; tramadol-bupiva-kain kombinasyonunun hemodinamik açıdan stabil bir anestezi sağlayarak ve benzer yan etkiler gösterek, postoperatif anal-jezi süresini fentanil-bupivakain ve bupivakain grubuna göre anlamlı derecede uzattığı kanısına varıldı.Öğe Geriatrik ve Non-geriatrik Yoğun Bakım Hastalarında Kolistin İlişkili Nefrotoksisite: Retrospektif Kohort Çalışması(Selçuk Üniversitesi, 2018 Aralık) Duman, İpek; Bayraktar, Yeşim Şerife; Duman, AteşAmaç: Kolistin (kolistimetat sodyum) son yıllarda çoklu ilaç direnci gösteren gram negatif bakterilerin oluşturduğu nozokomiyal enfeksiyonların tedavisinde kullanılmaktadır. Kolistin kullanımı sonucu gelişen ciddi advers etkiler arasında nefrotoksisite önemli bir yer tutar. Geriatrik hastalarda kolistin ve nefrotoksisite ilişkisine yönelik çalışmalar kısıtlıdır. Amacımız Yoğun Bakım Ünitesinde Acinetobacter baumannii enfeksiyonu nedeniyle kolistin tedavisi alan geriatrik (?65 yaş) ve nongeriatrik (<65yaş) hastalar arasında akut böbrek yetmezliği (ABY) gelişimi ile demografik veriler, laboratuvar ve klinik fizyolojik parametreler açısından farklılıkları değerlendirmekti. Gereç ve Yöntem: Hastaların akut fizyoloji ve kronik sağlık değerlendirmesi (APACHE II) skorları, diyabetes mellitus, vücut kitle indeksi (VKİ), yatış süresi ve nedenleri kaydedildi. Başlangıç ve tedavi sırasındaki en yüksek üre, kreatinin, albümin değerleri ile glomerüler filtrasyon hızları (GFR) değerlendirmeye alındı. Nefrotoksisite riski taşıyan ek ajan alıp almadığı da araştırıldı. Akut böbrek yetmezliği kriteri olarak renal replasman ihtiyacı alındı. Renal replasman tedavisi, vazopresör ilaç kullanımı ve mortalite sıklığı da kaydedildi. Gruplar arasındaki klinik ve laboratuvar verilere ilişkin farklılıklar istatistiksel olarak değerlendirildi. p<0,05 anlamlı kabul edildi. Bulgular: Geriatrik hastalarda ABY görülme sıklığı, diyabetes mellitus tanısı, APACHE II skoru, VKİ, başlangıç GFR değerleri ve kolistin sonrası en düşük GFR değerleri ile en düşük albümin değerleri nongeriatrik hastalara göre anlamlıydı. Gruplar arasında mortalite, hipertansiyon, septik şok, vazopresör kullanımı ve potasyum seviyelerinde fark yoktu. Sonuç: Acinetobacter baumannii enfeksiyonunda kolistin kullanılan geriatrik yoğun bakım hastalarında ABY sık gelişmektedir. Geriatrik hastalarda APACHE II skorlarının, VKİ’lerinin, diyabet, ABY ve renal replasman sıklığının nongeriatrik hastalara oranla daha yüksek olmasına karşın yaş grupları arasında mortalite farkı yoktur.Öğe Iliac artery ınjury during lumbar disc hernia surgery(ELSEVIER SCIENCE INC, 2019) Şahinoğlu, Mert; Arun, Oğuzhan; Orhan, Atilla; Nayman, Alaaddin; Çalışır, Akın; Bocu, Yasin; Cebeci, Yasemin; Duman, Ateş; Yılmaz, Hüseyin; Köktekir, Ender; Karabağlı, HakanBACKGROUND: Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications. CASE DESCRIPTION: A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure. However, the patient became hypotensive near the end of the operation. The incision was quickly closed, and she was turned to supine position. Emergency abdominal ultrasound, computed tomography, and computed tomography angiography revealed an injury of the left main iliac artery, which was repaired by endovascular stenting. Laparotomy and Bogota bag were applied because of increased intrabdominal pressure at 3 hours postoperative. In addition, a retroperitoneal catheter was placed into the area of the right retroperitoneal hematoma on the first postoperative day. Tissue plasminogen activator was administered through the catheter. On postoperative day 3, the Bogota bag was removed, and the abdomen was closed. The patient was discharged without neurodeficit on day 27. Her abdominal fascial defect was closed with a synthetic graft after 5 months. CONCLUSIONS: Although lumbar discectomy is one of the most commonly performed neurosurgical procedures, the routine rules of discectomy should not be neglected. Early detection and a multidisciplinary approach can help prevent mortality in the event of vascular injury.Öğe Karbondioksit ve Azotprotoksit Pnömoperitonyumunun Hemodinamik ve Kan Gazı Etkilerinin Yavru Köpek Modelinde Araştırılması(2000) Duman, Ateş; Yosunkaya, Alper; Öğün, Öztin Cemile; Abasıyanık, Adnan; Daşcı, ZaferLaparoskopi amacıyla oluşturulan pnömoperitonyum için kullanılan karbondioksit (COsub2/sub) ve azot protoksitin (Nsub2/subO) çocuklarda hemodinamiye ve kan gazlarına etkileri yavru köpek modeli kullanılarak araştırıldı. Köpekler (n22) xylazin ile premedike edilip, ketamin 30 mg.kgsup-1/sup (im) ile anestetiğe edildikten sonra, femoral arter ve safen venine kanüller yerleştirildi. Grup I'e (nII) intraperitoneal olarak 10-12 mmHg basınçla COsub2/sub, grup H'ye (nII) Nsub2/subO verildi. Kalp atım hızları (KAH), sistolik (SAB), diyastolik (DAB) ve ortalama (OAB) arter basınçları, kan gazlan (PaOsub2/sub, PaCOsub2/sub), solunum havasındaki end tidal karbon dioksit (ETCOsub2/sub) ve %Nsub2/subO değerleri işlem öncesi (kontrol) insuflasyon sonrası (İS) 15. dakika ve desuflasyon sonrası (DS) 15. dakikalarda kaydedildi. İstatistiksel değerlendirmede tekrarlayan ölçümlerde varyans analizi kullanıldı, p0.05 anlamlı kabul edildi. Grup I'de KAH, DAB, OAB, ETCOsub2/sub ve PaCOsub2/sub İS'da kontrole göre arttı. Grup II'de kontrole göre SAB, İS'da azalıp, DAB, DS'da arttı. Her iki grup arasında OAB İS zamanında, ETCOsub2/sub ise İS ve DS zamanlarında anlamlı farklılık gösterdi. Nsub2/subO insuflasyonu yapılan Grup II'de ekspiriyum havasında Nsub2/subO saptanmadı. Sonuçta; Nsub2/subO ile pnömoperitonyumun hiperkarbinin riskli olduğu çocuklarda COsub2/sub'e alternatif olabileceği kanısına varıldı.
