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    Addition of sufentanil to bupivacaine in caudal block effect on stress responses in children
    (BLACKWELL PUBLISHING, 2007) Erol, Atilla; Tuncer, Sema; Tavlan, Aybars; Reisli, Ruhiye; Aysolmaz, Gokhan; Otelcioglu, Seref
    Background: The aim of the present randomized study was to determine the effect of adding sufentanil to bupivacaine, compared with bupivacaine alone in caudal block, on the surgical stress response in children. Methods: The children were premedicated with midazolam 0.5 mg/kg. All children received induction with nitrous oxide and sevoflurane. Anesthesia was maintained with the same volatile agents in the both groups. The children were randomly allocated to two groups. Group I received bupivacaine alone (n = 17) and group II received bupivacaine + sufentanil (n = 16). Caudal block was performed with 0.25% bupivacaine 2 mg/kg (group I) or 0.25% bupivacaine 2 mg/kg with sufentanil 0.5 mu g/kg (group II) after induction of anesthesia. Blood samples were obtained after induction of anesthesia (T-0) to measure baseline concentrations of cortisol, prolactin, glucose and insulin. Additional samples were obtained 30 min after the start of surgery (T-1), and 60 min after the end of surgery (T-2). Results: All of the basal values (T-0) were within the normal ranges of the authors' laboratory for children of this age group and there were no differences between the groups (P > 0.05). In both groups, glucose concentration increased at T-1, compared with T-0 and T-2 (P < 0.05). The glucose concentration was unchanged at T-2 compared with T-0 in both group (P > 0.05). In both groups, prolactin concentration increased at T-1, compared with T-0 and decreased at T-2, compared with T-1 (P < 0.05). Cortisol decreased at T-1 and T-2, compared with T-0 in both groups. (P < 0.05). Insulin concentration remained unchanged at T-0 and T-2, but increased slightly at T-1 in both groups (P > 0.05). There were no significant differences in plasma prolactin, cortisol, glucose and insulin levels between the two groups at T-1 and T-2 (P > 0.05). Conclusion: There is no advantage in adding 0.5 mu g/kg sufentanil to bupivacaine over bupivacaine alone in the caudal block, with regard to the surgical stress response in children.
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    Auditory function after spinal anaesthesia: the effect of differently designed spinal needles
    (LIPPINCOTT WILLIAMS & WILKINS, 2009) Erol, Atilla; Topal, Ahmet; Arbag, Hamdi; Kilicaslan, Alper; Reisli, Ruhiye; Otelcioglu, Seref
    Background and objective Recurrent, bilateral or unilateral, persistent or transient, mild or profound hearing loss has been reported after spinal anaesthesia. We studied the effects of the needle type (Quincke, ballpen, pencil-point spinal needles) on hearing loss after spinal anaesthesia with the use of pure-tone audiometry. Methods Forty-five ASA physical status 1 patients scheduled for elective inguinal herniorraphy with spinal anaesthesia were enrolled in the study. The patients were randomly divided into three groups. Group Q (n = 15) patients received spinal anaesthesia through a 25-gauge (G) Quincke spinal needle, group B (n = 15) patients received the same through a 25-G ballpen spinal needle and those in group P (n = 15) received the same through a 25-G pencil-point spinal needle. Patients were interviewed about postoperative complaints such as postdural puncture headache, vertigo, nausea-vomiting, transient neurological symptoms and major neurological deficits. Pure-tone audiometry was performed by an audiologist at specific time intervals. Results The number of patients who had greater than 10 dB hearing loss in group Q was significantly more than that found in group B and group P at 250, 500, 4000 and 6000 Hz on postoperative day 1. When group B and group P were compared for change in hearing, no statistically significant difference was detected at any frequency tested. Conclusion Because the use of ballpen and pencil-point needles reduces hearing loss after spinal anaesthesia, these needles are preferred. Eur J Anaesthesiol 26:416-420 (c) 2009 European Society of Anaesthesiology.
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    Caudal anesthesia for minor subumbilical pediatric surgery: a comparison of levobupivacaine alone and levobupivacaine plus sufentanil
    (ELSEVIER SCIENCE INC, 2008) Erol, Atilla; Tavlan, Aybars; Tuncer, Sema; Topal, Ahmet; Yurtcu, Mueslim; Reisli, Ruhiye; Otelcioglu, Seref
    Study Objectives: To compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.20% with and without the addition of sufentanil 0.5 mu g kg(-1). Design: Prospective, randomized study. Setting: University teaching hospital. Patients: 40 ASA physical Status I pediatric Patients, aged one to 7 years, who were scheduled for elective minor subumbilical surgery. Interventions: Patients were divided into two groups to receive either a single caudal injection of one mL kg(-1) levobupivacaine 0.20% (Group L) or levobupivacaine 0.20% plus sufentanil 0.5 mu g kg(-1) (Group LS). Measurements: Analgesia (Children and Infants Postoperative Pain Scale score), motor block (Motor Blockade Scoring), and side effects were assessed at predetermined time points during the first 24 postoperative hours. Main Results: The Children and Infants Postoperative Pain Scale scoring at the first hour was significantly lower in Group LS than in Group L. No significant differences were found between the two groups for Pain scores at two, three, 4, 5 6 9 12, and 24 hours. Degree of motor block was comparable between the two groups. Conclusion: The effect of adding sufentanil to caudal levobupivacaine on postoperative pain scores is brief after elective minor subumbilical surgery in children. (C) 2008 Elsevier Inc. All rights reserved.
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    Determining the Effect of Sufentanil on Propofol Injection Pain
    (KUWAIT MEDICAL ASSOC, 2012) Saritas, Tuba Berra; Borazan, Hale; Kara, Inci; Tuncer, Sema; Otelcioglu, Seref
    Objectives: Propofol is a general anesthetic. Its most important disadvantage is pain on injection. Our aim was to evaluate the effectiveness of sufentanil on propofol injection pain (PIP). Design: Case control randomized double-blind study Setting: Anesthesia department of Selcuk University Meram Medical School, Turkey Subjects: A total of 160 adults, 18 to 65 years, ASA I-II patients, scheduled for operations under general anesthesia, were enrolled in this study. A 22-gauge intravenous (IV) catheter was inserted into a vein on the dorsum of the hand. Patients were randomly allocated to one of four groups to receive either saline or 0.5, 1, 2 mcg sufentartil in 2 ml volume. Thirty seconds after the intravenous (IV) injection of the pretreatment drug, 5 ml of 1% propofol at room temperature (Fresenius Kabi, Hamburg, Germany) was injected IV at rate of 0.5 ml/sec. Pain was assesed verbally and scored as none (0), mild (1), moderate (2), severe (3). Interventions: Prior injection of sufentanil or placebo Main Outcome Measures: Severity of PIP Results: Demographic data were comparable among four groups. Sufentanil at 1 and 2 mcg doses significantly decreased pain incidence when compared to the saline group (p < 0.05). Sufentanil 0.5 mcg had no effect.(p > 0.05). Although 2 mcg sufentanil decreased the incidence of PIP more than 1 mcg, there was no significant difference between these groups (p > 0.05). Conclusion: Sufentanil at one and 2 mcg doses reduced the incidence and severity of PIP
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    The Effects of 3 Different Intra-abdominal Pressures on the Thromboelastographic Profile During Laparoscopic Cholecystectomy
    (LIPPINCOTT WILLIAMS & WILKINS, 2011) Topal, Ahmet; Celik, Jale Bengi; Tekin, Ahmet; Yuceaktas, Ali; Otelcioglu, Seref
    Objective: The aim was to determine the influence of the pneumoperitoneum at 10, 13, and 16mm Hg on thromboelastograph (TEG) in laparoscopic cholecystectomy. Methods: Sixty patients were randomly allocated to 3 groups. The abdomen was insufflated with carbon dioxide to 10mm Hg (group 1), 13mm Hg (group 2), and 16mm Hg (group 3) intra-abdominal pressures. We evaluated changes in the TEG values [ reaction time (R), maximum amplitude (MA), alpha-angle, K time] preoperatively, intraoperatively, and postoperatively. Results: In the postoperative 24th hour, the R-value was significantly lower in group 3 than that in group 1 and group 2 (P< 0.05). We found increased values of MA intraoperative 30th minute and postoperative 24th hour in group 3 with respect to group 1 (P< 0.05) and postoperative 24th hour, and the MA value in group 3 was significantly higher than those of group 2 (P< 0.05). In group 3, the alpha-angle was significantly higher than that of group 1 and group 2 at intraoperative 30th minute and postoperative 24th hour (P< 0.05). In postoperative 24th hour, the K-value was significantly lower in group 3 than in group 2 and group 1 (P< 0.05). Conclusions: Laparoscopy with pneumoperitoneum at pressures of 10 and 13mm Hg did not alter the TEG values and low intra-abdominal pressure must be used for peritoneal insufflation.
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    Prevention of postoperative nausea and vomiting after thyroidectomy - Combined antiemetic treatment with dexamethasone and ginger versus dexamethasone alone
    (ADIS INT LTD, 2006) Tavlan, Aybars; Tuncer, Sema; Erol, Atilla; Reish, Ruhiye; Aysolmaz, Gokhan; Otelcioglu, Seref
    Background: The aim of this study was to compare the prophylactic effects of dexamethasone plus ginger and dexamethasone alone on postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. Methods: One hundred and twenty patients undergoing general anaesthesia for thyroidectomy were enrolled in this randomised, double-blind study. Patients received oral diazepam 10mg with either oral placebo (group I) or 0.5g of ginger (group II) as premedication 1 hour prior to surgery. Standard general anaesthetic techniques and postoperative analgesia were employed. Both group I and group II received intravenous dexamethasone 150 mu g/kg immediately before the induction of anaesthesia. Data were recorded over a 24-hour observation period after surgery. Results: In the dexamethasone-treated group, 14 patients experienced nausea, two patients retched, three patients vomited once, two patients vomited repeatedly, and 14 patients required a rescue antiemetic. In the dexamethasone-plus-ginger-treated group, 12 patients experienced nausea, one patient retched, four patients vomited once, no patients vomited repeatedly, and 13 patients required a rescue antiemetic. Dexamethasone plus ginger, did not significantly reduce nausea and vomiting compared with dexamethasone alone during the observation period. Conclusion: In conclusion, the prophylactic combination of antiemetic treatment with dexamethasone and ginger was not clinically or statistically superior to dexamethasone alone in preventing PONV in patients undergoing thyroidectomy.