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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 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 Dexketoprofen for postoperative pain relief [Postoperatif a?rida deksketoprofen kullanimi](2006) Tuncer S.; Tavlan A.; Köstekçi H.; Reisli R.; Otelcio?lu Ş.Dexketoprofen trometamol is a water-soluble salt of the dextrorotatory enantiomer of nonsteroidal anti-inflamatory drug ketoprofen. The aim of the study was to investigate the effect of dexketoprofen on postoperative pain. This study was performed on 50 (ASA I-II) patients planned for abdominal hysterectomy. Fifty patients were randomized into two equal groups. Patients received oral placebo (group I) and 25 mg dexketoprofen (group II) 1h before surgery and 8-16 h after surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received tramadol IV via a PCA (Patient Controlled Analgesia) -device. Pain scores and sedation scores were assessed at 3, 6, 12 and 24 h after surgery. Tramadol consumption, adverse effects, and patient satisfaction were noted during 24 h after the surgery. The pain scores were significantly lower in the dexketoprofen group compared with the placebo group p<0.05). The cumulative tramadol consumption was lower in the dexketoprofen group than placebo group (p<0.05). No significant difference was observed in sedation scores, adverse effects and patient satisfaction between the groups (p>0.05). We conclude that the preoperative and postoperative administration of dexketoprofen provided a significant analgesic benefit and decreased the opioid requirements in patients undergoing abdominal hysterectomy.Öğe The effects of desflurane, sevoflurane and propofol anaesthesia on bronchoalveolar lavage cells [Propofol, desfluran ve sevofluran anestezisinin bronkoalveolar lavaj hücreleri üzerine etkisi](2005) Çiçekci F.; Reisli R.; Toy H.; Sarkilar G.; Otelcio?lu Ş.This study compared the effects of desflurane, sevoflurane and propofol anaesthesia on alveolar macrophage, PMNL, bronchial epithelia cells and morphological structure. Sixty patients varying in age between 18 and 60 and scheduled to undergo extremity surgery were included in the study. Patients were randomly allocated to three groups consisting of 20 patients each. In all groups, general anesthesia was induced with 2-3 mg kg-1 of propofol, 1?g kg-1 of fentanyl, 0.6 mg kg-1 of rocuronium bromide. Anesthesia was maintained with 6% desflurane (Group D) and 2% sevoflurane (Group S) to obtain 1 MAC. In Group P, propofol infusion was started with a dose of 12 mg kg-1 h-1, which was reduced to 9, 6 and then 4 mg kg-1 at 20 minute intervals after the first dose. All patients were given 50% O2-50% dry air 4 L min-1. As required, patients were given rocuronium 0.2 mg kg-1, fentanyl 1?g kg-1. Bronchoalveolar lavage fluid (BAL) was collected following induction of anesthesia (T0) and at the 120th minute of the operation (T1). Mature and immature alveolar macrophages, PMNL and brochial epithelial cells in T0 and T1 preparation were counted under a light microscope. Comparison within each group indicated that there was a statistically significant difference in time dependent increase on PMNL augmentation and a decrease in bronchial epithelial cells. We concluded that during the two hour period of anesthesia and the operation, no changes were detected in bronchoalveolar lavage cells in the groups. As a result, we can say that no group showed superiority over the others. Further studies are needed to explain the time dependent increase in PMNL.Öğe The effects of sufentanil and remifentanil in the isolated perfused rat kidney [Sufentanil ve remifentanilin izole perfüze rat böbre?i üzerine etkileri](2004) Tuncer S.; Barişkaner H.; Yosunkaya A.; Kiliç M.; Do?an N.; Otelcio?lu Ş.In this study, the effects of indomethacin (prostaglandin synthase inhibitor), propranolol (beta adrenergic receptors blocker), tetraethylammonium (TEA) (calcium-dependent potassium channel blocker) and glibenclamide (ATP-sensitive potassium channel blocker), NG nitro-L-arginine (NO synthetase inhibitor) and naloxame (nonselective opioid receptor antagonists) on the responses induced by sufentanil and remifentanil were investigated in the isolated perfused rat kidney. Renal arter was cannulated. Then the kidney was perfused continueously with warmed (37 °C) and aerated (95% O 2 and 5% CO 2). Krebs Henselieit solution by using a peristaltic pump delivering a constat flow (8-10 ml/min). Vascular responses were detected as changes in perfussion pressure, which was monitored continuously with a pressure transuder and recorded on polygraph. After phenilephrine (PE)-induced vasoconstriction had reached a platoe, sufentanil or remifentanil were given. Vasodilatation was recorded. Antagonists or inhibitors were added and responses were recorded. At the end of each experiment; papaverine was used to obtain the maximum dilatation. None of the used antagonists or inhibitors were not effected the submaximum PE construction. The used opioids were not alter in basal perfusion pressure. Antagonists or inhibitors had no effect on papaverine-induced dilatation. Bolus addition of sufentanil and remifentanil produced concentration dependent vasodilation. Indomethacine L-NAME, propranolol, naloxone and glibenclamide did not significantly alter responses of both of the opioids (p>0.05). But, sufentanil and remifentanil induced dilatation were significantly affected by TEA (p<0.05). The present results demonstrated that sufentanil and remifentanil decrease perfusion pressure in the isolated rat kidney and such mechanism may involve the calcium actived K + channels activation.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 Transdermal fentanyl for neuropathic pain: A case report [Nöropatik a?rida transdermal fentanil kullanimi: Olgu sunumu](2006) Tuncer S.; Reisli R.; Kara I.; Otelcio?lu Ş.The mechanisms responsible for neuropathic pain are not fully understood. Most treatment modalities are ineffective or insufficient for this important clinical condition. Better understanding of pain mechanisms and opioid drug action has widened the indications for opioids in pain therapy of non-malignant pain including neurophatic pain. In this report of a female patient with chronic non-malignant neurophatic pain was followed-up for pain and side effects, for approximately fourteen months with the use of transdermal fentanyl (TDF). Pain reduction was good throughout the study. Severe side effects did not occur. TDF was effective and well tolerated in the treatment of chronic neuropathic pain of non-malignant origin.