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Öğe Combined use of ultrasound guided infraclavicular block and lateral femoral cutaneous nerve block in upper extremity reconstruction requiring large skin graft: Case report(2013) Kiliçaslan A.; Erol A.; Topal A.; Selimoglu M.N.; Otelcioglu Ş.Combined nerve blocks of the upper extremity and lower limb in same operation rarely performed due to the risk of systemic toxicity of local anesthetics. Therefore, general anesthesia is generally preferred in this operations. However, use of ultrasound allows reliable deposition of the anesthetic around the nerves, potentially lowering the local anesthetic requirement. In this case report, we present a 44-year-old, ASA physical status I, male patient who was operated for upper extremity reconstruction requiring skin graft from anterolateral thigh region under ultrasound-guided infraclavicular brachial plexus block and lateral femoral cutaneous nerve block. The block was successful and no block-related complications were noted. We think that combining an ultrasound guided infraclavicular brachial plexus block and a lateral femoral cutaneous nerve block is a clinically useful and safe technique and an alternative anesthetic method for procedures requiring skin grafts for the upper extremity.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 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.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 A comparison of the effects of intraoperative tramadol and ketamine usage for postoperative pain relief in patients undergoing tonsillectomy [I?ntraoperatif tramadol ve ketaminin tonsillektomi uygulanan hastalarda ameliyat sonrasi a?ri üzerine etkilerinin karşilaştinlmasi](2013) Sizer C.; Kara I.; Topal A.; Çelik J.B.Objectives: We aimed to compare the effects of ketamine and tramadol administered intraoperatively on postoperative pain and analgesic demand in children undergoing tonsillectomy operations. Methods: Ninety children undergoing tonsillectomy, aging 5-15 years old, with ASA I - II, were included in this study. Cases were arranged in three groups and given standardized general anesthesia. After coagulation, ketamine (0.5 mg.kg-1) was administered intravenously (iv) in the ketamine group, and tramadol iv (2 mg.kg-1) was given in the tramadol group and the control group received a physiologic iv. The duration of anesthesia, duration of operation, and length of stay in the PACU were recorded. NRS and CHEOPS scales were used to assess postoperative pain. Paracetamol (15 mg.kg-1) was given rectally in the first 6 hours (hrs) and orally over the subsequent 6 hrs, if NRS greater than 3 and CHEOPS greater than 8 were observed. All data were recorded concerning the initial and total dosage of analgesic and the presence of complications within 24 hrs. Results: Demographic data, duration of anesthesia, duration of operation, and duration of stay in the PACU were similar between groups (p>0.05). The number of patients requiring additive analgesic was higher in the control group. No differences were found between the tramadol and ketamine groups (p>0.05). Additional analgesic was given earlier in the control group (p<0.05), but the need for additional analgesic was similar in tramadol and ketamine groups (p>0.05). Paracetamol dosage was significantly higher in the control group (p<0.05), but similar between the tramadol and ketamine groups (p>0.05). The frequency of nausea and vomiting was found to be significantly higher in tramadol and ketamine groups compared to the control group (p<0.05). Conclusion: Postoperative pain was effectively managed using 2 mg.kg-1 tramadol and 0.5 mg.kg-1 ketamine in pediatric tonsillectomies.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 Metilentetrahidrofolat redüktaz C677T mutasyonlu olguda anestezi uygulaması(AVES, 2011) Kiliçaslan A.; Topal A.; Erol A.; Eryilmaz M.; Otelcio?lu S.[Abstract not Available]
