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Öğe Effect of caudal block on stress responses in children(BLACKWELL PUBLISHING ASIA, 2004) Tuncer, S; Yosunkaya, A; Reisli, R; Tavlan, A; Cicekci, F; Otelcioglu, SBackground: The present study was performed during lower abdominal and genitourinary surgery, to assess the effects of caudal block on plasma cortisol, prolactin, insulin and glucose concentrations during and after surgery. Methods: Thirty male children aged 3-10 years who were scheduled for elective surgery, were selected for the study. The children were premedicated with oral midazolam 0.5 mg/kg. All children received induction with nitrous oxide in oxygen and sevoflurane. The children were randomly allocated into two groups: Group I, control group (n=15) and group II, caudal group (n=15). Anesthesia was maintained by face mask with the same agent in both groups. Caudal block was performed with 0.25% bupivacaine 2 mg/kg after induction of anesthesia in the caudal group. Blood samples were obtained after induction of anesthesia (T-0) in order 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 accepted by Meram Medical Faculty of Selcuk University 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 values (P<0.05). However glucose concentration was lower in the caudal group than in the control group at T-1 (P<0.05). In both groups, prolactin concentration increased at T-1, compared with T-0 (P<0.05). The mean plasma prolactin and cortisol concentration were lower in the caudal group than the control group at T-1 and T-2 (P<0.05). The mean insulin concentration was lower in the caudal group than the control group at T-2 (P<0.05). Conclusion: These results indicate that caudal anesthesia suppresses the metabolic and endocrine responses to stress associated with lower abdominal and genitourinary surgery in children.Öğe The effect of environmental tobacco smoke on the dose requirements of rocuronium in children(BLACKWELL PUBLISHING LTD, 2004) Reisli, R; Apilliogullari, S; Reisli, I; Tuncer, S; Erol, A; Okesli, SBackground: Smoking affects the pharmacodynamic and pharmacokinetic behaviour of several drugs. The aim of this study was to evaluate the effects of environmental tobacco smoke on onset and recovery time after single dose rocuronium in children. Methods: Forty children between 4 and 10 years were enrolled into the study. Children who have no familial smoking history were included in the first group whereas passive smokers included in the second group. Sevoflurane in 50% O-2 and 50% N2O was used for induction of anaesthesia. Evoked adductor pollicis electromyography was used to monitor neuromuscular block. The T-95 and T-25 values were recorded. Results: The T-95 values (+/-SD) for rocuronium were 110.1 +/- 39.3 s and 79.3 +/- 35.6 s for group 1 and group 2, respectively (P < 0.05). The T-25 value of group 2 was 40.1 +/- 10.6 min and compared with group 1 values (30.85 +/- 7.02 min) it was significantly longer (P < 0.01). Conclusion: This study shows that passive smoking children consume less rocuronium than nonsmokers during similar anaesthesia. We think that a history of passive smoking must also be taken into consideration during preoperative evaluation of paediatric patients.Öğe Effect of gamma-hydroxybutyric acid on lipid peroxidation and tissue lactate level in experimental head trauma(LIPPINCOTT WILLIAMS & WILKINS, 2004) Yosunkaya, A; Ak, A; Bariskaner, H; Ustun, ME; Tuncer, S; Gurbilek, MBackground. This study was designed to determine the effects of gammahydroxybutyric acid (GHB) on tissue lactate and malondialdehyde (MDA) levels in rabbit brain after experimental head trauma. Methods. Thirty New Zealand rabbits were divided equally into three groups: group S was the sham-operated group, group C, and group GHB received head trauma, where group C was the untreated and group GHB was the treated group. Head trauma was delivered by performing a craniectomy over the right hemisphere and dropping a weight of 10 g from a height of 80 cm. GHB was administered 400 mg/kg intravenously for 10 minutes after the head trauma to group GHB. The nontraumatized side was named "1" and the traumatized side was named "2." One hour after trauma, brain cortices were resected from both sides and the concentrations of lactate and MDA were determined. Results There were significant differences between lactate and MDA levels of group S and all other groups (C-1, C-2, GHB(1), and GHB(2)) except between lactate levels of group S and group GHB(1), the nontramnatized and traumatized sides of groups C and group GHB, group C-2 versus group GHB(2), and group C-1 versus group GHB(1) (p < 0.05). Rectal temperature after the administration of GHB in group GHB was found lower than in groups S and C (p < 0.05). Conclusion. These results demonstrate that head trauma leads to an increase in brain tissue lactate and MDA levels, and GHB effectively suppresses the increase of lactate and MDA.Öğe The effects of adding diphenhydramine hydrochloride to lidocaine in intravenous regional anaesthesia(VSP BV, 2003) Reisli, R; Celik, J; Tuncer, S; Apilliogullari, S; Duman, A; Yosunkaya, A; Okesli, SThis study aimed to evaluate whether diphenhydramine hydrochloride (DPH) could be used to reduce the dose of lidocaine for intravenous regional anaesthesia (IVRA). Sixty patients undergoing upper limb operations were divided into three groups (20 each). All patients received IVRA as follows: group 1 received 3 mg/kg lidocaine, group 2 received 40 mg DPH and 1.5 mg/kg lidocaine, and group 3 received 1.5 mg/kg lidocaine diluted to 40 ml with 0.9% saline solution. The onset of sensory block was tested by a pinprick. The duration of anaesthesia time was also recorded. Intraoperative pain was assessed using a five point pain score system. Side effects during surgery and after release of the tourniquet were recorded. Only 4 patients in group 3 had sufficient analgesia. Therefore, the patients in group 3 were excluded from the study. Data from 40 patients (group I and 2) were analysed. The onset time of sensory block was significantly shorter in group I than group 2 (2.4 +/- 1.54 min and 6.85 +/- 1.46 min, respectively). The tourniquet pain time was also significantly longer in group I than in group 2 (57.15 +/- 10.90 min and 42.65 +/- 9.67 min, respectively). One patient from each group experienced tinnitus for 30-60 s, and 4 patients in group 2 had minimal sedation after tourniquet release. According to our results, DPH is a safe and useful adjunct to IVRA in minor procedures of short duration. Decreasing the dose of lidocaine also decreases the risk of local anaesthetic toxicity in the event of accidental release of tourniquet pressure.Öğe Effects of isoflurane and sevoflurane on the survival of skin flaps in rats(TAYLOR & FRANCIS AS, 2005) Tosun, Z; Tuncer, S; Yosunkaya, A; Ozkan, A; Senturk, S; Savaci, NThe effects of inhalational anaesthetic agents on survival of flaps are not well known. We investigated the effect of isoflurane and sevoflurane anaesthesia on survival of flaps using a caudally-based McFarlane skin flap in 20 male Wistar rats. Sevoflurane 1 minimum alveolar concentration (MAC) and isoflurane (1 MAC) in oxygen mixture was given to the animals. A 4 x 10 cm caudally-based standard McFarlane flap was raised. There were no differences in any haemodynamic values or blood gases between the sevoflurane group and the isoflurane group. Skin flaps were assessed on the seventh day. The isoflurane group had a significantly smaller area of skin flap necrosis and an increased area of flap surviving than the sevoflurane group. We conclude that survival is significantly improved when isoflurane is used as the inhalational anaesthetic rather than sevoflurane.Öğe The relaxant effects of alfentanil and remifentanil on noradrenaline-treated rat aorta(VSP BV, 2003) Tuncer, S; Bariskaner, H; Dogan, NBackground and objective: In this in vitro study on rat thoracic aorta, the effects of indomethacin (a prostaglandin synthesis inhibitor), propranolol (a beta adrenergic receptor blocker), tetraethylammonium (TEA) (a calcium-actived potassium channel blocker), glibenclamide (an ATP-dependent potassium channel blocker) and naloxone (an opioid receptor antagonist) on the responses induced by alfentanil and rernifentanil were investigated. Methods: Aortas isolated from rats were cut into spiral strips 12 mm in length, 3 mm wide. Strips were mounted in organ baths at 37degreesC continuously gassed with 95% and 5% CO2. The responses of the drugs were recorded isometrically on polygraph. Results: In both groups, strips were precontracted with 10(-6) M noradrenaline (NA). Then alfentanil or remifentanil (10(-8) to 10(-5) M) was administered cumulatively. Both alfentanil and rernifentanil significantly produced relaxation (p < 0.05). Indomethacin, propranolol, TEA, glibenclamide and naloxone did not significantly modify responses of the opioids. The rank order of potencies of these drugs was alfentanil > remifentanil. Conclusion: Prostaglandins, beta adrenergic receptors, potassium channels and opioid receptors have no role in the responses induced by alfentanil and remifentanil.
