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Öğe Anesthetic management of a case with rett syndrome [Rett sendromlu bir olguda anestezik yaklaşım](AVES, 2011) Saritaş T.B.; Babacan K.; Sarkilar G.; Ökesli S.Rett syndrome (RS) is a progressive genetic disorder affecting mainly females. It is usually caused by a mutation in X-linked gene MECP2. After Down syndrome, Rett syndrome is the second leading cause of mental retardation seen in girls. Respiration disorders, EEG and EKG abnormalities spasticity, advanced muscle wasting and dystonia, peripheral motor dysfunction, scoliosos require precision, and attention in preoperative preparation and anesthetic management. We want to evaluate the anesthetic management of Rett Syndrome in this case presentation.Öğe Anesthetic management of a patient with myasthenia gravis during cardiac surgery (case report) [Kardiyak cerrahide miyastenia gravisli hastada anestezik yaklaşim](2008) Sarkilar G.; Narin C.; Duman A.; Ökesli S.Myasthenia gravis (MG) is an autoimmune disorder mainly caused by antibodies against the muscle acetylcholine receptors at the neuromuscular junction. Loss of these receptors lead to a defect in neuromuscular transmission resulting with muscle weakness and fatigue. The use of muscle relaxants has remained controversial because patients with myasthenia gravis are known to be sensitive to their effects. The unpredictable susceptibility to muscle relaxants in patients with MG requires special considerations for anesthetic management. Experiences related to induction and maintenance of cardiac anesthesia without the use of muscle relaxant in patients with myasthena gravis are limited. In this report; induction and maintanence of anesthesia with sufentanil and propofol without neuromuscular block has been represented in a patient with MG undergoing cardiac surgery.Öğe The combination of sevoflurane and thoracic epidural anesthesia without using muscle relaxant in patients with myasthenis gravis Undergoing thymectomy [Timektomi Uygulanacak Miyestenia Gravis Olgularinda Nöromüsküler Bloker Kullanilmaksizin Sevogluran ve Torasik Epidural Anestezi Kombinasyonu](2003) Öztin Ö?ün C.; Duman A.; Sarkilar G.; Çelik J.B.; Ökesli S.; Aribaş O.In this prospective study, we combined induction with sevoflurane inhalation without neuromuscular blocking drugs, with thoracic epidural anesthesia for myasthenia gravis (MG) patients planed for transsternal thymectomy. We aimed to assess and present the procedure, respiratory and hemodynamic effects of this combination and our experiences during the intraopertative and postoperative periods. Inhalation induction with sevoflurane was performed in 7 MG patients with previous pulmonary function testing, following insertion of thoracic epidural catheters. Intubation was performed without neuromuscular blocker drugs. Sevoflurane and thoracic epidural analgesia were used together for maintenance. In all patients, arterial blood gases were monitored beside hemodynamic and respiratory parameters. End tidal sevoflurane concentrations which provides anesthetic depth was recorded. Continuous epidural analgesia was provided in the postoperative period in all patients. Paired t test, chi-square and Wilcoxon-match paired-tests were used for statistical analysis. All patients well tolerated induction with inhalation and intubation. The hemodynamic and respiratory parameters showed similar changes. The mean end tidal sevoflurane concentration of the patients for surgical anesthesia was 2.4±0.4 %. Postoperative pulmonary complications or respiratory depression were not encountered in any patient. As a conclusion, induction and maintenance with sevoflurane, combined with thoracic epidural anesthesia may be preferred in MG patients undergoing thymectomy. It was considered that, thoracic epidural anesthesia as a good choise for the stabilization of the postoperative period.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.
