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Öğe Combined use of ultrasound guided infraclavicular block and lateral femoral cutaneous nerve block in upper extremity reconstruction requiring large skin graft: Case report(2013) Kiliçaslan A.; Erol A.; Topal A.; Selimoglu M.N.; Otelcioglu Ş.Combined nerve blocks of the upper extremity and lower limb in same operation rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in this operations. However, use of ultrasound allows reliable deposition of the anesthetic around the nerves, potentially lowering the local anesthetic requirement. In this case report, we present a 44-year-old, ASA physical status I, male patient who was operated for upper extremity reconstruction requiring skin graft from anterolateral thigh region under ultrasound-guided infraclavicular brachial plexus block and lateral femoral cutaneous nerve block. The block was successful and no block-related complications were noted. We think that combining an ultrasound guided infraclavicular brachial plexus block and a lateral femoral cutaneous nerve block is a clinically useful and safe technique and an alternative anesthetic method for procedures requiring skin grafts for the upper extremity.Öğe A comparison of general anesthesia with general anesthesia plus epidural levobupivacaine or bupivacaine [Genel anestezi ve genel anestezi ile birlikte uygulanan epidural levobupivakain veya bupivakain anestezisinin karşilaştirilmasi](2008) Çalimli S.; Topal A.; Erol A.; Tavlan A.; Otelcio?lu Ş.Aim: In this study, we aimed to compare the effects of general anesthesia and general anesthesia combined with epidural anesthesia, using two different local anesthesics levobupivacane or bupivakaine on the response to surgical stress, intraoperative hemodynamics, recovery, advers effects and postoperative analgesia. Materials and Methods: Fiftyfour patients scheduled for TAH-BSO were randomly divided into three groups,. General anesthesia+epidural bupivacaine group (Group I), general anesthesia+epidural levobupivacaine group (Group II) and general anesthesia group (Group III) were assigned. Lomber epidural catheter was placed in Group I and Group II. Anesthesia was induced in Group I and Group II, after T6 sensorial block were achieved. Anaesthesia induction was performed with propofol 2 mg kg-1, remifentanil 1 ? kg-1 min-1 and rocuronium 0.6 mg kg-1, in all groups. Anaesthesia maintanence was provided with in 50 % O2-air, 1 % sevoflurane and 0.1 ?g kg-1 min-1 remifentanil infusion. Blood glucose, Cortisol, insulin and CRP were measured. Preoperatively and postoperative 1st and 24th hours. All patients assessed in terms of hemodynamic values, the levels of sensorial and motor block, total dose of sevoflurane and remifentanil used intraoperatively, recovery, VAS and side effects. Epidural bupivacaine+morphine patient controlled analgesia (PCA) was used in Group I, epidural levobupivacaine +morphine PCA was used in Group II and iv morphine PCA was used in Group III, for postoperative pain management. Results: There were no significant diffirences between Group I and Group II in terms of time to reach to T6 dermatome, maximum sensorial block level, and motor block (p>0.05). Total remifentanil, sevoflurane and neuromusculer blocker requirements were greater in Group III compared to other two groups (p<0.05). Spontane respiration time, extubation time, eye opening time, ?9 Aldrete Recovery Score time to were statistically longer in Group III than Group I and Group II (p<0.05). Glucose, insulin and CRP values were similar at all times, among the groups (p>0.05). Cortisol values increased at 1st hour postoperatively in Group III than Group I and Group II (p<0.05). VAS values were greatest at the 0. minutes in Group III, but there were no diffirence at other times. In terms of postoperative side effects, nause-vomiting and pruritis were more frequent in Group III, but these were not statistically significant (p>0.05). Conclusion: According to these results, we concluded that epidural bupivacaine's and levobupivacaine's effects were similar in our study and we also concluded that epidural anaesthesia combined with general anaesthesia; provide better hemodynamic stability and analgesia postoperatively, suppressed stres response compared to general anaesthesia. Keywords: Bupivacaine, epidural anaesthesia, general anaesthesia, levobupivacaine, stress respons.Öğe Comparison of intranasal midazolam and midazolam-sufentanil for premedication in children [Çocuklarm premedikasyonunda i?ntranazal midazolam ve midazolam-sufentanilin karşilaştirilmasi](2008) Topal A.; Erol A.; Tavlan A.; Kiliçaslan A.; Yalçm N.Aim: We aimed to compare the effect of midazolam and the combination of low dose of midazolam and sufentanil applied intranasal on sedation, hemodynamic parameters and recovery in children for premedication. Materials and Methods: 50 children scheduled for elective tonsillectomy and/or adenoidectomy were randomized into two groups: Group M (n=25): received midazolam 0.2 mg kg -1, Group M/S (n=25): received 0.1 mg kg-1 midazolam plus 0.75 ?g kg-1 sufentanil intranasal 20 minutes before anesthesia induction. Mean arterial pressure, heart rate, pulse oximetry and Ramsey sedation scores were recorded before and after premedication. The moods of children at the time of separation from parents are recorded as silence or not. The response to venous canulation was assessed operation desk. Anesthesia induction was provided with % 8 sevoflurane in 50 % O2-50 % N 2O and 10 ?g kg-1 alfentanil. The response to face mask was evaluated as accept/deny. Anesthesia was maintained with % 2-3 sevoflurane in 50 % O2-50 % N2O mixture. Postoperative agitation and pain level were determined with Davis Score and POPS respectively. Results: There were no difference in hemodynamic parameters between the groups (p>0.05). Children's mood at the time of seperating from parents, response to face mask, POPS and Davis scores at postoperative 30th minute in Group M, response to venous canulation in Group M/S were significally better (p<0.05). There were no significant difference with respect to Davis and POPS scores measured at postoperative 10th minutes (p>0.05). Conclusions: Midazolam-sufentanil combination used in this study was not found to be a good alternative to midazolam only.Öğe Comparison of propofol-remifentanil and desflurane-remifentanil anesthesia for intracranial mass surgery [İntrakraniyal kitle cerrahisinde propofol-remifentanil ile desfluran-remifentanil anestezisinin karşilaştirilmasi](2006) Tavlan A.; Erol A.; Topal A.; Dayto?lu M.; Kara I.; Otelcio?lu Ş.Aim: In this study, we aimed to evaluate the effects of propofol-remifentanil and desflurane-remifentanil anaesthesia on haemodynamics and recovery in elective intracranial mass surgery. Materials and Methods: Forty cases, ASA I-III, between 18-63 years age were randomly assigned into two groups (Group I: Propofol, Group II: Desflurane). All of the cases were premedicated with 0.03 mg kg-1 midazolam, anaesthesia induced with 1 mg kg-1 lidocaine and 1 ?g kg-1 remifentanil intravenous (iv) bolus in 60 seconds. At the same time remifentanil infusion 0,5 ?g kg-1 min-1 was started. After remifentanil administration, 2 mg kg-1 propofol applied to the patient. After dural opening, remifentanil infusion decreased 50 % of the beginning rate. Anaesthesia maintained in the first group with 6 mg kg-1 h -1 propofol infusion and in the second group with 3 % desflurane concentration to mean arterial pressure between 60-100 mmHg. Heart rate (HR), mean arterial pressure (MAP), recovery criteria, perioperative complications were evaluated. Results: In Group I. MAP was higher at 2 minutes (t3) and 10 minutes (t4) after intubation; during head holder application (t5) (respectively; p=0.008, p=0.008, p=0.013). Ten minutes after head holder application (t7) and at dural incision (tB) MAP was higher in Group II (p=0.030, p=0.037). When groups were compared according to heart rates, at 2 minutes (t3) and 10 minutes (t 4 after intubation decrement in Group II was higher (respectively; p=0.001. p=0.001). However, during head holder application (t5), ten minutes after head holder application (t7) and at durai incision (t8) decrement in Group I was higher than Group II (respectively; p=0.002, p=0.010, p=0.007). In Croup II eye opening, and extuhation times were shorter (respectively; p=0.005, p=0.001). Conclusion: In conclusion, we decided that remifentanil combined desflurane and propofol anesthesia suppressed the intraoperative hemodynamic responses efficiently but desflurane remifentanil combination had a shorter recovery time in intracranial mass surgery.Öğe The effects of intravenous dexketoprofen on postoperative analgesia and morphine consumption in patients undergoing abdominal hysterectomy [Abdominal histerektomi uygulanan olgularda intravenöz deksketoprofenin postoperatif analjezi ve morfin tüketimine etkisi](2010) Tuncer S.; Reisli R.; Keçecio?lu M.; Erol A.Objectives: Dexketoprofen trometamol is a water-soluble salt of the dextrorotatory enantiomer of the nonsteroidal anti-inflammatory drug ketoprofen. The aim of this study was to investigate the effect of intravenous dexketoprofen on postoperative pain. Methods: This study was performed on 50 (ASA I-II) patients scheduled for abdominal hysterectomy. Fifty patients were randomized into two equal groups. Patients received saline solution (Group I) or 50 mg intravenous dexketoprofen (Group II) 1 hour (h) before surgery and 8-16 h after surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received intravenous (IV) morphine via a PCA (patient- controlled analgesia) device. Pain scores were assessed at 2, 6,12 and 24 h after surgery. Morphine consumption and adverse effects were noted during the first 24 h after the surgery. The pain scores were significantly lower in the dexketoprofen group compared with the control group (p<0.05). Results: The cumulative morphine consumption was also lower in the dexketoprofen group than the control group (p<0.05). No significant difference was observed in adverse effects between the groups (p>0.05). Conclusion: We conclude that the administration of IV dexketoprofen provided a significant analgesic benefit and decreased the morphine requirements in patients undergoing abdominal hysterectomy.Öğe The effects of preemptive dexketoprofen use on postoperative pain relief and prmadol consumption [Preemptif deksketoprofen kullaniminin postoperatif a?ri ve tramadol tüketimine etkisi](2011) Kaka I.; Tuncer S.; Erol A.; Reisli R.Onjectives: In this study, the efficacy of preemptive dexketoprofen usage on postoperative pain relief and tramadol consumpation was evaluated. Methods: Fifty American Socity of Anestbesiologists(ASA)-I or ASA-II patients undergong plastic surgery were randomized into two groups. Groups. 1 received dexketoprofen 25 mg and Group 2 received placebo tablets 1 hour (h) before surgery. All patients received a standard anesthetic protocol. At the end of the surgery, all patients received intravenous tramadol with Patient Controlled Analgesia (PCA) device. Pain scores was evaluated with visual analog scale during the postoperative 1st, 8th and 24th h. Tramadol consumption, adverse effects and patient satisfaction were recorded. Results: The pain scores and tramadol consumption were significantly lower in Group 1 (p<0.05). Nausea and vomiting were observed more in Group 2 than Group 1, and patient satisfaction was better in Group 1 (p<0.05). Conclusion: Preemptive use of dexketoprofen reduced postoperative tramadol consumption and incidence of adverse events.Öğe The effects of the administration of suhfacial levohupivacaine infusion with the ON-Q pain pump system on postoperative analgesia and tramadol consumption in cesarean operations [Sezaryen cerrahisinde on-q a?ri pompa sistemi ile uygulanan subfasiyal levobupivakain infüzyonunun postoperatif analjezi ve tramadol tüketimine etkisi](2010) Tuncer S.; Aysolmaz G.; Reisli R.; Erol A.; Yalçin N.; Yosunkaya A.Objectives: In this study, the effects of administration of suhfacial levobupivacaine infusion with the ON-Q pain pump system were investigated in elective cesarean operations for postoperative pain control and tramadol-sparing effect. Methods: Fifty ASA I-II patients scheduled for cesarean operation were enrolled into this study. Patients were randomly divided into two groups: Group I served as a control group, without the ON-Q pain pump system, whereas Group II received the ON-Q pain pump system with subfacial 0.25% levobupivacaine infusion for 24 hours at 4 ml/hour. All patients received a standard anesthetic protocol At the end of the surgery, all patients received tramadol i.v. via a PCA (Patient Controlled Analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 hours postoperatively. Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. Results: The pain scores were significantly lower in the levobupivacaine group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the levobupivacaine group than in the control group (p<0.05). Group II used less antiemetic and had less postoperative nausea and vomiting and the difference was statistically significant (p<0.0S). Conclusion: No complication occurred as a result of the ON-Q pain pump system. Subfacial levobupivacaine infusion with the ON-Q pain pump system diminished postoperative pain and the need for tramadol use following cesarean operations.Öğe Evaluation of hemostatic changes during isoflurane and desflurane anaesthesia using thrombelastography in intracranial mass surgery [İntrakraniyal kitle cerrahisinde desfluran ve i?zofluran anestezisinin hemostatik sistem üzerine olan etkilerinin tromboelastografi yöntemi ile de?erlendirilmesi](2008) Dursun M.; Tavlan A.; Topal A.; Erol A.; Otelcio?lu Ş.Aim: The aim of this study is evaluation of hemostatic changes during isoflurane and desflurane anaesthesia using thrombclastography in intracranial mass surgery. Material and Methods: Fourty ASA I-III patients between ages 18-65 undergoing supratentorial craniotomy operations were included in the study. Heart rate, mean arterial pressure, peripheral oxygen saturation, PaCO 2, ETCO2 pressure, peripheral body temperatures were monitorized. All patients were applied 1 pg kg-1 remifentanil iv bolus for 60 seconds during anaesthesia induction. Following the remifentanil application, 2 mg kg-1 iv bolus propofol was applied. After loss of consciousness, tracheal intubation was faeiliated with 0.5 mg kg-1 atracurium. For maintenance of anaesthesia, 0.5 MAC isoflurane for group I, 0.5 MAC desflurane for group D was used. TEG parameters were performed preoperatively, at the 60th minute of induction, and at 24th hour postoperatively. Results: No statistically significant difference was present in measurement of reaction time, coagulation time, alpha angle and maximum amplitude values among and in between the groups (P>0,05). Conclusion: In this study we compared hemostatic changes during isoflurane and desflurane anaesthesia using thrombclastography in intracranial mass surgery; we concluded that both desflurane and isoflurane do not change TEG parameters, do not have any negative effect on hemostatic system and can be used safely in major surgery such as intracranial mass surgery.Öğe Metilentetrahidrofolat redüktaz C677T mutasyonlu olguda anestezi uygulaması(AVES, 2011) Kiliçaslan A.; Topal A.; Erol A.; Eryilmaz M.; Otelcio?lu S.[Abstract not Available]Öğe Premptive analgesia with ketamine or tenoxicam before remifentanil anesthesia [Remifentanil anestezisinden önce ketamin ve tenoksikam ile preemptif analjezi](2003) Öztin Ö?ün C.; Duman A.; Erol A.; Kirgiz E.N.; Ökesli S.; Duman I.The postoperative analgesic effectiveness and side effects of preemptive ketamine and tenoxicam, which were used before remifentanil-based anesthesia, were compared in gynecological laparotomies. Before anesthesia induction, 4 ml saline i.v. was administered to Group P (n=31), 1 mg/kg ketamine to Group K (n=30) and 40 mg tenoxicam to Group T (n=33). Anesthesia was induced with 1-1.5 mg/kg propofol and 0.6 mg/kg rocuronium and maintaned with 0.2 mg/kg/hour remifentanil and 67 % nitrous oxide and sevoflurane. Sedation, pain scores and meperidine consumptions (after extubation and at 3, 6, 12, 24, 48th hours) were recorded. Hemodynamic and respiratory variables were similar in all groups. Sedation level was higher in ketamine group than placebo (p<0.05). Pain scores were lower in Group K than placebo at first 6 hours and at 48th hour, but pain scores were lower in Group T than placebo at all times (p<0.05). Meperidine consumption was lower at 6, 12, 24th hour than the other groups in Group T, it was similar between tenoxicam and ketamine groups in 3rd, 48th hour and totally (p<0.05). It was thought that preincisional tenoxicam has preemptive effectiveness but ketamine does not, although it has a short analgesic effect and is likely to prevent hyperalgesia.
