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    Comparison of alfentanil and remifentanil at total intravenous anesthesia in short-term elective surgery [Kisa süreli cerrahi girişimlerde alfentanil ve re?ifentanilin tiva'da karşilaştirilmasi]
    (2002) Özel M.; Yosunkaya A.; Tavlan A.; Reisli R.; Ökesli S.
    In our study, adding alfentanil as an opioid analgesic to propofol for total intravenous anesthesia in short-term elective surgery was compared to remifentanil. We aimed to study the anesthesia induction, maintenance and recovery characteristics of the two drugs. This study was carried out on 50 patients in ASA I-II group. They were between the ages of 18-60 and they were planned to be discharged from the hospital in 1-2 days. They were randomised into two groups, 20 ?g kg-1 alfentanil was given to group I and 1 ?g kg-1 remifentanil iv to group II patients as bolus injection, 2 ?g kg-1 min-1 alfentanil and 0.5 ?g kg-1 min-1 remifentanil iv infusion was also started respectively. Following this, these two group of patients were intubated by applying 2 mg kg-1 propofol+0.15 mg kg-1 vecuronium iv bolus and 90 ?g kg-1 min-1 iv propofol infusion. Alfentanil and remifentanil infusions were halfened 5 min after tracheal intubation and propofol infusion was decreased to 60 ?g kg-1 min-1 30 min after beginning. All patients were vetilated with 100 % O2 during the operation. Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and heart rate measurements were recorded before anesthesia, 1, 3, 5 min after remifentanil or alfentanil application, after the intubation and skin incision, and during surgery every 10. min. The haemodynamic and somatic responses to intubation-skin incision and surgical stimulation were identified. After operation, recovery time and adverse events were recorded. The response to tracheal intubation and skin incision was less in remifentanil group than in alfentanil group, statistically considerable difference was not identified. No differences were compared in the evaluation of times, seeing reponse to surgical. A smaller proportion of remifentanil patients than alfentanil patients had required addition opioid doses during maintenance (p < 0.05). When comparing the recovery period of each group, it was significantly shorter in the remifentanil group than in the alfentanil group (p < 0.05). These two groups were similar in the aspect of observing postoperative adverse events. As a result, we think that remifentanil can be prefered to alfentanil as an addition opioid agent in TIVA which is applied for short-term surgical procedures because a smaller remifentanil patients require a study opioid adjustments needed to treat light anesthesia responses and remifentanil provides rapid recovery.
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    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.
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    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.
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    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.
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    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.
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    Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: Perioperative haemodynamics and anaesthetic requirements
    (2006) Yildiz M.; Tavlan A.; Tuncer S.; Reisli R.; Yosunkaya A.; Otelcioglu S.
    Background: Dexmedetomidine reduces the dose requirements for opioids and anaesthetic agents. The purpose of this study was to evaluate the effect of a single pre-induction intravenous dose of dexmedetomidine 1 ?g/kg on cardiovascular response resulting from laryngoscopy and endotracheal intubation, need for anaesthetic agent and perioperative haemodynamic stability. Methods: Fifty patients scheduled for elective minor surgery were randomised into two groups (dexmedetomidine group and placebo group, n = 25 in each group). During and after drug administration, the Ramsey sedation scale was applied every 5 minutes. Fentanyl 1 ?g/kg was administered to all patients and thiopental was given until lash reflex disappeared. Anaesthesia continuation was maintained with 50%:50%, oxygen:nitrous oxide. Sevoflurane concentration was adjusted to maintain systolic blood pressure within 20% of preoperative values. After extubation, the Steward awakening score was applied at 5 and 10 minutes. Haemodynamic parameters and adverse effects were recorded every 10 minutes for 1 hour after surgery. Results: During intubation the need for thiopental and sevoflurane concentration were decreased by 39% and 92%, respectively, in the dexmedetomidine group compared with the placebo group. In all groups, blood pressure and heart rate increased after tracheal intubation; both were significantly lower in the dexmedetomidine group than in the placebo group (p < 0.05). Fentanyl requirement during the operation was 74.20 ± 10.53?g in the dexmedetomidine group and 84.00 ± 27.04?g in the placebo group (p < 0.05). At 5 minutes, the Steward scores were >6 in 56% of the dexmedetomidine group and in 4% of the placebo group (p < 0.05). At 10 minutes, sedation scores were ?4 in all patients in the dexmedetomidine group (p < 0.05). Arterial blood pressure and heart rate in the postoperative period were significantly lower in the dexmedetomidine group compared with the placebo group (p < 0.05). Conclusion: Preoperative administration of a single dose of dexmedetomidine resulted in progressive increases in sedation, blunted the haemodynamic responses during laryngoscopy, and reduced opioid and anaesthetic requirements. Furthermore, dexmedetomidine decreased blood pressure and heart rate as well as the recovery time after the operation. © 2006 Adis Data Information BV. All rights reserved.
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    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.