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Öğe 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, SerefBackground: 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.Öğe Anaesthetic and Haemodynamic Effects of Continuous Spinal Versus Continuous Epidural Anaesthesia With Prilocaine(Greenwich Medical Media Ltd, 2003) Reisli, Ruhiye; Çelik, J.; Tuncer, S.; Yosunkaya, Alper; Otelcioğlu, S.Background and objective: To compare, using prilocaine, the effects of continuous spinal anaesthesia (CSA) and continuous epidural anaesthesia (CEA) on haemodynamic stability as well as the quality of anaesthesia and recovery in patients undergoing transurethral resection of the prostate gland. Methods: Thirty patients (>60 yr) were randomized into two groups. Prilocaine, 2% 40 mg, was given to patients in the CSA group, and prilocaine 1% 150 mg was given to patients in the CEA group. Incremental doses were given if the level of sensory block was lower than T-10 or if needed during surgery. Results: There was a significant decrease in mean arterial pressure in Group CEA compared with Group CSA (P < 0.01). The decrease in heart rate in Group CSA occurred 10 min after the first local anaesthetic administration and continued through the operation (P < 0.05). The level of sensory anaesthesia was similar in both groups. The times to reach the level of T-10 and the upper level of sensory blockade (T-max) were 18.0 +/- 4.7 and 25.3 +/- 7.0 min in Groups CSA and CEA, respectively, and were significantly longer in Group CEA. The duration of anaesthesia was 76.8 +/- 4 min and was shorter in Group CSA (P < 0.01). Conclusions: Spinal or epidural anaesthesia administered continuously was reliable in elderly patients undergoing transurethral resection of the prostate. Continuous spinal anaesthesia had a more rapid onset of action, produced more effective sensory and motor blockade and had a shorter recovery period. Prilocaine appeared to be a safe local anaesthetic for use with either continuous spinal anaesthesia or continuous epidural anaesthesia.Öğe 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, SerefBackground 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.Öğe 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, SerefStudy 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.Öğe Çocuklarda Desfluran-Sevofluran Anestezisinin İdame ve Derlenme Üzerine Olan Etkilerinin Karşılaştırılması(2003) Uzun, Süleyman; Tuncer, Sema; Tavlan, Aybars; Reisli, Ruhiye; Sarkılar, Gamze; Ökeşli, SelminBu çalışmada çocuklarda kısa süreli cerrahi girişimlerde anestezi idamesinde kullanılan desfluran ve sevofluranın özellikleri karşılaştırıldı. Yaşları 4-12 olan 50 çocuk çalışmaya alındı. Anestezi indüksiyonundan 30 dk önce 0.5 mg kg-1 midazolam oral uygulandı. Anestezi indüksiyonu için 2-2.5 µg kg-1 propofol, 10 µg kg-1 alfentanil ve 0.1 mg kg-1 sisatrakuryum verildikten sonra hastalar randomize olarak iki gruba ayrıldı ve anestezi idamesi için % 60 N2O ile birlikte % 6-7 desfluran (grup I) ve 2-2.5 % sevofluran (grup II) uygulandı. Cerrahi başlamadan önce, hastalara postoperatif analjezi için 20 mg kg-1 parasetamol rektal uygulandı. Postoperataif bulantıkusma insidansını azaltmak için 150 µg kg-1 deksametazon verildi. Sistolik arter basıncı, diyastolik arter basıncı, ortalama arter basıncı ve kalp atım hızı indüksiyon öncesi, indüksiyon ve entübasyon sonrası, cerrahi başladıktan 5., 10. ve 20. dk. sonra ve anestezi sonunda kaydedildi. Anestezik ajanlar ameliyat bitiminde kesildi. Ekstübasyon ve derlenme zamanı kaydedildi. Ajitasyon üç puanlı skorlama ile değerlendirildi. Her iki grupta da hemodinamik parametreler bazal değerlerin % 30'unda seyretti. Derlenme zamanı desfluran grubunda daha kısa bulundu (p0.05). Ekstübasyon zamanı ve ajitasyon insidansı iki grupta benzer bulundu (p0.05). Her iki grupta postoperatif kusma insidansında istatistiksel olarak anlamlı farklılık bulunmadı (p0.05). Sonuç olarak çocuklarda propofol indüksiyonu sonrası desfluran ve sevofluranın anestezi idamesinde güvenle kullanılabileceği kanısındayız.Öğe Çocuklarda Kaudal Bupivakain ve Bupivakainsufentanilin Postoperatif Analjezik Etkileri(2003) Tuncer, Sema; Yosunkaya, Alper; Reisli, Ruhiye; Tavlan, Aybars; Köstekci, Hatice; Otelcioğlu, ŞerefKaudal blok, çocuklarda alt abdominal, rektal ve urogenital cerrahi sonrası postoperatif analjezi için yaygın kullanılan bir yöntemdir. Bu çalışmada kaudal blok uygulanan çocuklarda, bupivakaine ilave edilen sufentanilin postoperatif analjezi süresine etkisini ve yan etkilerini değerlendirmeyi amaçladık. Bu çalışma fakülte etik kurul onayı alınarak ASA I-II grubu 3- 10 yaşlan arasında alt abdominal ve penoskrotal girişim planlanan 52 olguda yapıldı. Cerrahinin sonunda çocuklar randomize olarak iki gruba ayrıldı ve postoperatif analjezi için kaudal blok yapıldı. Grup l'e (n26) l ml kg-1 % 0.125 bupivakain, Grup II'ye (n26) 0.5 mug kg-1 sufentanil %0.125 bupivakain aynı volümde (l ml kg-1 ) uygulandı. Olgular postoperatif dönemde 24 saat süreyle gözlendi. Postoperatif ağrı Modifiye Pediatrik Objektif Ağrı Skalası (MPOPS) ile değerlendirildi. Analjezi süreleri, ek analjezik ihtiyacı ve yan etkiler kaydedildi. Ayrıca servis hemşirelerinden çocukların davranışlarını ve annelerinden de uyku kalitelerini (0neşeli/sakin, lhuzursuz, 2gergin/ağlamaklı) değerlendirmeleri istendi. Olguların demografik verileri benzerdi. Gruplar arasında analjezi süresi ve yan etkiler bakımından farklılık bulunmadı (p0.05). Fakat sufentanil eklenen gruptaki çocuklar neşeli ve daha sakindi. Kaudal blok uygulanan çocuklarda bupivakaine eklenen sufentanil analjezi süresini etkilememekte fakat daha kaliteli analjezi sağlamaktadır.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 A Comparative Study of the Effect of Rofecoxib (a COX 2 Inhibitor) and Naproxen Sodium on Analgesic Requirements After Abdominal Hysterectomy(2003) Çelik, Jale Bengi; Tuncer, Sema; Reisli, Ruhiye; Sarkılar, Gamze; Çelik, Çetin; Akyürek, CemalettinThis study evaluated the analgesic efficacy of administering preoperatively rofecoxib or naproxen sodium to patients undergoing abdominal hysterectomy. A randomized, double-blinded prospective study was conducted with 60 women undergoing elective abdominal hysterectomy under general anesthesia. Patients were randomly allocated into one of three equally sized groups. Patients in the first group received rofecoxib 50 mg 1 h before operation (group R), patient in the second group received naproxen sodium 550 mg 1 h before surgery (group N) and patients in the third group received a placebo tablet in the same time (group P). Total amount of used morphine mixture was higher in placebo group (93±6 ml) than in the group R (50±4 ml) and group N (64±6 ml). There were significant difference for total amount of used morphine mixture between group P and other two groups. There was significant difference in the volumes of morphine mixture used in the first 12 h in group P and other two groups. The occurrence of side effects such as, dyspepsia, epigastric discomfort, heartburn, were similar in group R and group P. However, this side effects were increased in group N. Rofecoxib receiving preoperatively was provided clinical efficacy for postoperative pain control and well tolerated for gastrointestinal side effects comparable with naproxen sodium.Öğe Comparison of Different Doses of Sufentanil for Control of Hemodynamic Response to Tracheal Intubation [trakeal Entübasyonda Oluşan Hemodinamik Yanitin Kontrolünde Sufentanilin Farkli Dozlarinin Karşilaştirilmasi](2003) Tuncer S.; Reisli, Ruhiye; Yosunkaya, Alper; Tavlan, Aybars; Uzun S.; Ökesli S.In our study, we aimed to determine the most appropriate, sufficient, and safe dose of sufentanil in the hemodynamic response to laringoscopy and intubation. This study was performed on 45 ASA I-II physical status, without cardiovascular illness, normotansive patients planned for elective surgery. Patients were randomized into three equal groups. All patients received an intravenous midazolam premedication (0.03 mg kg-1. Ten minutes after, 0,1 ?g kg-1 sufentanil in Group I (GI), 0.15 ?g kg-1 sufentanil in Group II (GII) and 0.2 ?g kg-1 sufentanil in Group III (GIII) were administrated intravenously. About two minutes after, all patients received 2 mg kg-1 propofol and 1.5 mg k-1 succinylcholine. The patients were intubated under direct laringoscopy. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and heat rate (HR) were measured: at the beginning (10 min. qfter midazolam applicati-on) (tO), before propofol (tl), before laryngoscopy (t2), 1 and 3 minutes after the tracheal intubation (t3,t4). When the group parameter values were evaluated, it was observed that there was an significant increase in HR after the intubation (t3,t4) in G I (p>0.05). In G II SAP was significantly decrease after induction (t2) when compared with tO (p<0.05). All hemodyaamic parameter values (SAP, DAP, MAP, HR) were found significantly decrease at t2, t3, t4 in G III (p<0.05). When the groups were compared, there were no differences in all measurement times in the aspect of hemodynamic parameter values between G I and G IIH (p>0.05). SAP, MAP, HR values at t3 and SAP, DAP, MAP, HR at t4 were found significantly lower in G III than in G I (p<0.05) and HR values at t3, t4 were found significantly lower in G III than G II (p<0.05). Bradycardia occurred in seven patients in G III. As a result; We think that 0.15 ?g kg-1 sufentanil was safe and satisfactory to suppress the response after laryngoscopy and tracheal intubation in healthy normotensive patients without cardiovascular disease.Öğe Comparison of Maintenance and Recovery Characteristics of Desflurane and Sevoflurane in Children [çocuklarda Desfluran-sevofluran Anestezisinin İdame Ve Derlenme Üzerine Olan Etkilerinin Karşilaştirilmasi](2003) Uzun, S.; Tuncer, S.; Tavlan, Aybars; Reisli, Ruhiye; Sarkilar, Gamze; Ökesli S.In this study, the characteristics of desflurane and sevoflurane were compared for maintenance of anaesthesia in short-term surgery of children. Fifty children, 4-12 years old were studied. Thirty minutes prior to the induction of anaesthesia, all patients received 0.5 mg kg-1 midazolam orally. They were randomly assigned to receive 6-7 % desfurane (group I) and 2-2.5 % sevoflurane (group II) with 60 % nitrous oxide in oxygen for maintenance of anaesthesia. For anaesthesia induction all patients were given 2-2.5 mg kg -1 propofol, 10 ?g kg-1 alfentanil and 0.1 mg kg -1 cisatracurium and after two minutes all patients were intubated. Before surgery, patients received 20 mg kg-1 paracetamol rectally for postoperative analgesia. Dexamethasone 150 ?g kg-1 was given to reduce the incidence of postoperative nausea and vomiting. Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and heat rate were measured: before induction, after induction and during intubation, 5, 10, 20 minutes after surgery and at the end of anaesthesia. At the end of the operation extubation and recovery times were determined. Agitation was evaluated by using the three -point score. Hemodynamic parameters were satisfactorily maintained within ± 30 % of baseline values in both groups. Recovery time was significantly shorter in the desflurane group than sevoflurane group (p<0.05). Extubation time and incidence of agitation were similar for both groups. Differences in the incidence of postoperative vomiting were not statistically significant between the groups. As a result, we concluded that both sevoflurane and desflurane can be used safely for the maintenance of anaesthesia after induction of propofol in children.Öğe A Comparison of Ropivacaine With Bupivacaine for Pediatric Caudal Block [çocuklarda Kaudal Blok Uygulanmasinda Bupivakain I?le Ropivakainin Karşilaştirilmasi](2001) Tuncer, S.; Orhan, R.; Çelik, J.; Reisli, Ruhiye; Tavlan, A.; Ökesli, SelminCaudal anaesthesia is a widely used method for lower abdominal, penoscrotal and lower extremity surgery in children. The aim of this study was to evaluate the quality of anaesthesia, the effects on hemodynamic parameters, postoperative pain and side effects of ropivacaine and bupivakaine in caudal anaesthesia. All patients received rectal midazolam 0.4 mg/kg for premedication 30 minutes before surgery. After routine monitorization, patients were randomized into two groups. All patients received 2-2.5 mg/kg bolus propofol intravenously and then propofol infusion was continued through the operation. Immediately after propofol bolus Group I (n=20) received 2 mg/kg 0.25% bupivacaine and Group II (n=20) received 2 mg/kg 0.2% ropivacaine for caudal anaesthesia. Heart rate, arterial blood pressure, SpO2 was measured 5 and 15 minutes after caudal blockade and every 15 minutes until discharged from the operating room. Postoperative pain was assessed according to Modified Pediatric Objective Pain Scale (MPOPS). The level of anaesthesia was satisfactory in both groups. No further analgesia was required. Heart rate, arterial blood pressure, SpO2 and the values of MPOPS were similar in both groups. 45% of Group I and 40% of Group II didn't need postoperative analgesia. As a result, we concluded that ropivacaine (2 mg/kg 0.2%) is as efficacious as bupivacaine (2 mg/kg 0.25%) anaesthesia and postoperative analgesia for caudal anesthesia in children.Öğe Comparison of the Effects of Intravenous and Thoracic Epidural Patient-Controlled Analgesia With Morphine After Upper Abdominal Surgery(VSP Bv, 2003) Yosunkaya, Alper; Tavlan, Aybars; Tuncer, Sema; Reisli, Ruhiye; Topal, Ahmet; Ökesli, SelminOur purpose was to compare the effects of patient-controlled analgesia (PCA) with intravenous (i.v.) and epidural morphine on pulmonary function and their analgesic efficacy and side effects after upper abdominal surgery. In a prospective study, patients were randomly allocated to receive either thoracic epidural (n = 20) or intravenous (n = 20) patient-controlled analgesia with morphine. Preoperatively and at 24 and 48 h after surgery, arterial blood-gas analysis, forced vital capacity (FVC), and forced expiratory volume in 1s (FEV1) were measured, and chest X-ray films were taken from all patients. Pain (at rest), morphine consumption, nausea and vomiting, pruritus, and respiratory rate were recorded during the first 48 postoperative hours. In this period, the amount of morphine that was used in the epidural PCA group (28.5 +/- 7.4 mg) was significantly lower than in the i.v. PCA group (49.4 +/- 27.0 mg). Pain scores were similar in the two groups. Throughout the study no differences were found in pH(a), PaCO2, PaO2, FVC or FEV1 between epidural and i.v. morphine groups. When compared with preoperative data, at 24 and 48 h after surgery, FVC, FEV1, and PaO2 decreased significantly in both groups (p < 0.05). Except pruritus, incidence of side effects occurred similarly in the two groups. In this study, we found no difference between the effects of epidural and i.v. administration of morphine with PCA on pulmonary function and analgesic efficacy.Öğe Effect of Gabapentin on Postoperative Pain: A Randomized, Placebo-controlled Clinical Study(2005) Tuncer, Sema; Bariskaner, Hulagu; Reisli, Ruhiye; Şarkılar, Gamze; Çiçekçi, Faruk; Otelcioğlu, ŞerefBackground: Both clinical and experimental studies suggest that gabapentin (GBP) has analgesic effects in neuropathic pain. The aim of the study was to investigate the effect of gabapentin on postoperative pain. Methods: This study was performed on 45 (ASA I-II) patients planned for major orthopaedic surgery. 45 patients were randomized into three equal groups. Patients received 1200 mg GBP (Group I), 800 mg GBP (Group II) or placebo (Group III) 1 h before surgery. Anaesthesia was standardized for all patients. Morphine by intravenous patient-controlled analgesia was applied as 1 mg bolus dose and 7 min lockout time for postoperative analgesia. The pain was evaluated at the first 2 and 4 h after operation. The amount of morphine used was recorded at the same hours. Results: In all groups, there were no significant differences in the demographic characteristics, duration of surgery and anaesthesia, or dose of fentanyl received in the operating room. Pain scores and side effects were similar in all groups. Morphine consumption was lower in the Groups I and II than in the Group III at 2 h and 4 h postoperatively (p < 0.05). Morphine consumption was lower in the Group I than in the Group II at 2 h and 4 h (p < 0.05). Conclusion: Our results demonstrate that a single dose of 1200 or 800 mg oral gabapentin reduces morphine consumption in the early postoperative period. However, gabapentin 1200 mg is more effective than gabapentin 800 mg for pre-emptive analgesic effect.Öğe The Effects of Caudal Bupivakaine and Bupivakaine +sufentanil on Postoperative Analgesia in Peadiatric Patients [çocuklarda Kaudal Bupivakain Ve Bupivakain +sufentan?l?in Postoperatif Analjezik Etkile?i](2003) Tuncer, Sema; Yosunkaya, Alper; Reisli, Ruhiye; Tavlan, Aybars; Köstekci, H.; Otelcioğlu, Ş.Caudal block is a widely used method for postoperatif analgesia after lower abdominal, rectal and urogenital surgery in children. The aim of this study was to determine whether the addition of sufentanil to bupivacaine caudally prolongs the duration of analgesia and side effects compared with bupivacaine alone. Aged 3-10, fifty two boys were allocated randomly to two groups at the end of surgery. Children in group I received 0.125% bupivacaine 1 ml kg-1, group II received 0.5 ?g kg-1 sufentanil + 0.125% bupivacaine caudally. Postoperative pain was assessed according to Modified Pediatric Objective Pain Scale (MPOPS) 2, 4, 6, 8, 16 and 24h after operation. Time for first administration of analgesic, total number of analgesic doses required and side effects were recorded. Demeanor assessment was made according to tree-point scale (0= cheerful/calm, 1=restless, 2= tense/tearful) by ward nurse. No significant differences were found between two groups for the pain scores. There was no significant difference in the requirement for additional doses of analgesia. More Patients who had received caudal sufentanil with bupivacaine were cheerful and calm compared with those in bupivacaine group. The addition of sufentanil to bupivacaine for caudal block does not affect the analgesia duration but provides a quality analgesia in children.Öğe Effects of desflurane, sevoflurane and propofol on phagocytosis and respiratory burst activity of human polymorphonuclear leucocytes in bronchoalveolar lavage(LIPPINCOTT WILLIAMS & WILKINS, 2009) Erol, Atilla; Reisli, Ruhiye; Reisli, İsmail; Kara, Reyhan; Otelcioğlu, ŞerefBackground and objective In polymorphonuclear leucocytes, phagocytosis and respiratory burst activity are mainly responsible for bacterial killing. We aimed to investigate the effects of anaesthesia with desflurane, sevoflurane and propofol on these functional activities of polymorphonuclear leucocytes in bronchoalveolar lavage fluid. Methods Sixty patients scheduled to have tympanoplasty surgery were studied. The patients were divided into three groups (group D, desflurane; group S, sevoflurane; group P, propofol). Anaesthesia was induced with propofol, fentanyl and rocuronium in all groups. Anaesthesia was maintained with inhalation agent or propofol. Bronchoalveolar lavage was performed immediately after induction of anaesthesia and after surgical procedure by a fibreoptic bronchoscope. Leucocyte respiratory burst and phagocytic activity in bronchoalveolar lavage fluid were determined by flow cytometric analysis of gated leucocyte populations within 2 h after each bronchoalveolar lavage sample. Changes in leucocyte functions with time were expressed as mean fluorescence intensity. Results There were no significant differences in phagocytic activity of polymorphonuclear leucocytes within and between the groups. The respiratory burst function of polymorphonuclear leucocytes showed a significant increase after surgery in group P (P<0.05). When we compared the differences between the three groups, we found the difference in mean fluorescence intensity as statistically significant between group P and group S. Conclusion This study showed that propofol anaesthesia increased the respiratory burst function of polymorphonuclear leucocytes in bronchoalveolar lavage fluid. Eur J Anaesthesiol 26:150-154 (c) 2009 European Society of Anaesthesiology.Öğe The Effects of Halothane and Sevoflurane on Qtc Interval(2000) Reisli, Ruhiye; Çelik, J.; Özdemir, K.; Tavlan, A.; Apillioğlu, S.; Ökeşli, S.Prolongation of the QT interval may cause hazardous arrhythmias. The effects of halothane and sevoflurane on the Q T interval (QTc) have been investigated during induction of anaesthesia in 30 ASA I-II class patients. No premedication was used to avoid the effects of other anaesthetic agents. Anaesthesia was induced with either halothane (n=15) or sevoflurane (n=15), and inspired concentration was increased gradually to achieve a constant initial end-tidal concentration of 2 MAC. After pupils came to midline 0.05 mg/kg atracurium was administered and end-tidal concentration was reduced to 1 MAC. Recordings of ECG, heart rate, systolic and diastolic arterial blood pressure were obtained at the following times: prior to induction of anaesthesia, after the lost of eye slash reflex, 3 min following atracurium administration, 1 and 3 min after tracheal intubation. QT interval was corrected for the heart rate (QTc). Both halothane and sevoflurane prolonged QTc one minute after the tracheal intubation, but it was statistically significant only in sevoflurane group (p<0.05). The heart rate increased 1 and 3 rain after tracheal intubation with sevoflurane (p<0.05). In both groups, systolic and diastolic arterial blood pressures decreased after induction of anaesthesia (p<0.05). In conclusion the prolongation of the QTc interval by halothane and sevoflurane suggests that caution should be used during administration of these agents to patients with long QTc syndrome.Öğe The Effects of Repeated Sevoflurane Anaesthesia on Neonatal Rat Liver: the Role of Soda Lime [Tekrarlayan Sevofluran Anestezisinin Yavru Rat Karaciğeri Üzerine Etkileri: Sodalaym'in Rolü](2003) Ünal, M.; Reisli, Ruhiye; Tuncer, Sema; Erol, Atilla; Avunduk, M.; Ökesli, S.Experimental studies indicate that repeated exposure to sevoflurane can be hepatotoxic. It may be either related with direct effect of this anaesthetic agent or with the degradation of sevoflurane by soda lime which is also known to produce toxic products. The aim of this study was to investigate the effects of repeated sevoflurane anaesthesia on liver in neonatal rats with or without soda lime. Twenty seven rats were used in the experiment (15-30 g weight). The rats were randomly divided into three groups (9 each). The rats were placed in a specially prepared transparant plastic box. Group C was the control group. They received 100% O2. In the anaesthesia circle without sodalime sevoflurane in 2.5-2.7 % concentration with O2 (100%) were administered directly in group S, while the same gas mixture was applied through the soda lime in group, SS. Repeated anaesthesia (five times) was applied to the rats for sixty minutes with two days intervals. SGOT, SGPT and ALP levels were measured from the blood samples. Following sacrifice on the day ten, liver tissue samples were examined using light microscopy for histopathological evaluation. SGOT, SGPT and ALP levels were increased especially in group SS. There were only minimal changes in histopathological evaluation of liver from both experimental groups which were not statistically significant. As a result repeated sevoflurane anaesthesia with or without sodalime has minimal effects on liver.Öğe The effects of sevoflurane, desflurane and propofol on chemotactic functions of neutrophils in bronchoalveolar lavage [Bronkoalveolar lavaj (bal) sivisindaki nötrofillerin kemotaktik fonksiyonlari üzerine sevofluran, desfluran ve propofol anestezisinin etkileri](2007) Acat, C.; Erol, Atilla; Topal, A.; Reisli, Ruhiye; Reisli, İsmail; Otelcioğlu, ŞerefAim: We aimed to investigate the effects of anesthesia with desflurane, sevoflurane or propofol on chemotactic activity of neutrophils in bronchoalveolar lavage (BAL) material using with flow cytometry. Materials and Methods: The study includes thirty patients ages ranging from 18 to 40 with ASA class I. The patients were divided into three group (Group D=Desflurane, Group S=Sevoflurane, Group P=Propofol). All patients were premedicated with diazepam and atropin. Systolic and diastolic blood pressure, oxygen saturation, end-tidal CO2 values and minimum alveolar concentration of desflurane and sevoflurane were recorded. 2-3 mg kg-1 propofol, 1 mcg kg -1 fentanyl and 0,6 mg kg-1 rocuronium bromur were administered to all patients in the induction of anesthesia. The anesthesia was maintained with inhalation agent (1-1, 5 MAC) or propofol (the starting dose 12 mg kg-1 of propofol infusion was reduced to 9, 6 and a final 4 mg kg-1). Bronchoalveolar lavage was performed immediately after induction of anesthesia and surgical procedure by fiberoptic bronchoscop. The basal active cell ratios (BACR) and N-formyl-met-leu-phe (fMLP)-stimulated active cell ratios before and after anesthesia were determined by flow cytometry in BAL neutrophils. Results: Demografic properties, durations of anesthesia and surgery and hemodynamic parameters were similar between the groups. In group P, the basal active cell ratios (BACR) before administration of propofol compared to the BACR after administration of propofol were high. After propofol anesthesia, the fMLP-stimulated active cell ratios (SACR) were significantly higher than the BACR. In group D, after desflurane anesthesia the SACR were significantly higher than the BACR. In group S before and after administration of sevoflurane, there were no statistically significant difference between BACR and SACR. Conclusion: This study showed that sevoflurane was the least effective agent on chemotaxis of BAL neutrofils.Öğe The Effects of Sevoflurane, Desflurane and Propofol on the Percentages and Activation Molecules of the Lymphocytes: A Flow Cytometry Analysis of Bronchoalveolar Lavage Fluid(ORTADOGU AD PRES & PUBL CO, 2011) Erol, Atilla; Reisli, Ruhiye; Reisli, İsmail; Otelcioğlu, ŞerefObjective: We aimed to investigate the effects of anesthesia with desflurane, sevoflurane or propofol on the cell surface markers and the activation molecules of the lymphocytes in bronchoalveolar lavage (BAL) fluid via flow cytometry. Material and Methods: Sixty patients were scheduled for elective surgery. The patients were divided into three groups (Group D=desflurane, Group S= sevoflurane, Group P= propofol). The same induction agents were used for all groups. The anesthesia was maintained with an inhalation agent (1-1,5 MAC) or propofol (the starting dose 12 mg.kg(-1) of propofol infusion was reduced to 9, 6 and then 3-6 mg.kg(-1)). BAL was performed immediately after induction of anesthesia and surgical procedure with a fiberoptic bronchoscop. Blood pressures, oxygen saturation, end-tidal CO(2) values and minimum alveolar concentration of agents were recorded. The percentages of the lymphocytes and their activation molecules were determined by flow cytometry in BAL samples. Results: The percentages of active cytotoxic T-cells (CD8(+)CD25(+).) and active B cells (CD19(+) HLA-D12(+)) decreased after desflurane anesthesia. The percentage of cytotoxic T-cells decreased after propofol anesthesia. The anesthesia with sevoflurane had no effect on the percentages and the activation molecules of the lymphocytes in the BAL fluid. Conclusion: This study showed that desflurane and propofol decreased either the percentages of the cell surface markers or the activation molecules of the lymphocytes during perioperative period in a tissue sample whereas the sevoflurane had no effect on these parameters. We conclude that sevoflurane has no effect on the lymphocytes in the BAL sample.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.
