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Öğe Adding Ketoprofen to Intravenous Patient-Controlled Analgesia With Tramadol After Major Gynecological Cancer Surgery: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial(I R O G Canada, Inc, 2003) Tuncer, Sema; Pirbudak, Lütfiye; Balat, Özcan; Capar, M.Ketoprofen is a NSAIDs of the 2-aryl propionic acid class commonly used in the treatment of inflammatory rheumatic disease, acute pain and fever. Clinically, ketoprofen seems to reduce morphine requirements by 33 to 40% with ketoprofen's supposed central mechanism of analgesia. We evaluated the efficacy and safety of intravenous (IV) ketoprofen as an adjuvant to IV PCA (patient con- trolled analgesia) with tramadol after major gynecological cancer surgery for postoperative analgesia. Fifty patients were enrolled in this double-blinded, randomized, placebo-controlled study. Patients were allocated randomly to two groups: group I (25 patients) served as a control group, with patients receiving saline; group II (25 patients) received ketopro- fen. Patients received an intravenous bolus of saline or 100 mg ketoprofen at the end of surgery. Then, PCA was given as a 20 mg tramadol bolus and 10 min lockout time. Pain relief was regularly assessed using a visual analog scale. Tramadol consumption, side effects, and patient satisfaction were noted during the 24 hours after the surgery. No significant difference was observed in pain score, side-effects and patient satisfaction between the groups (p > 0.05). The cumulative PCA-tramadol consumption was lower in the ketoprofen-treated patients than placebo-treated patients (p < 0.05). Our results demonstrate that a single dose of 100 mg ketoprofen reduced tramadol consumption for treatment of postoperative pain after major gynecological cancer surgery.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 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 Closure Versus Nonclosure of Peritoneum at Cesarean Section: Evaluation of Postoperative Pain(VSP Bv, 2003) Tuncer, Sema; Çapar, Metin; Yosunkaya, Alper; Tavlan, Aybars; Otelcioğlu, ŞerefOur purpose was to evaluate postoperative opioid requirements in the closure or nonclosure of peritoneum at cesarean section. Eighty patients who were to undergo cesarean delivery were randomly assigned to two groups. The operative technique was randomized to include either nonclosure of both visceral and parietal peritoneum (study group) or closure of both layers (control group). Operating time and duration of general anesthesia was recorded. The pain was evaluated at rest in the first 12, 24 and 36 h after operation. The amount of morphine used was recorded at the same hours. The mean operating and anesthesia time were significantly longer in the control group than in the study group. Visual analogue scale (VAS) showed no difference in postoperative pain comparing closure to nonclosure of the peritoneum but patients of the control group required significantly more postoperative opioids. In conclusion, nonclosure of the visceral and parietal peritoneum reduces operating time and postoperative opioid medication.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 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 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 A Comparison of the Hemodynamic and Metabolic Effects of Extraperitoneal Carbon Dioxide and Nitrous Oxide Insufflation(EXCERPTA MEDICA INC, 2001) Aksoy, Faruk; Belviranlı, Metin; Vatansev, Celalettin; Tuncer, Sema; Yol, Serdar; Özergin, Ufuk; Atabek, MustafaBackground: The aim of the present study was to compare the hemodynamic and metabolic effects of extraperitoneal carbon dioxide (CO2)and nitrous oxide. (N2O) insufflation. Material and methods: Fourteen dogs were used in the experiment. All the animals were intubated under general anesthesia. A catheter was placed into the right juguler vein for central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), and heart rate (HR) monitorization. End-tidal CO2 pressure was measured by a capnometer connected to the endotracheal tube. Another catheter was inserted into the left femoral artery for arterial blood gas analysis and blood pressure monitorization. The preperitoneal dissection was made from a 1.5 cm subumbilical incision by using a preperitoneal dissection balloon. A laparoscope was placed in the preperitoneal space and the gas insufflation was kept at a constant pressure of 12 mm Hg throughout the experiment. All the study parameters were measured at the beginning of the insufflation and at every 15 minutes for 1 hour. Results: Mean artery pressure increased with time in both groups, but the increase was only significant in the CO2 group. PWP, CVP, PAP, and HR increased slightly in both groups, but there was no significant difference between the groups. The end-tidal CO2 increased in the CO2 group but decreased from the baseline in the N2O group. A significant acidosis was observed in only the CO2 group. PaCO2 significantly increased in the CO2 group; hence, PaCO2 slightly decreased in N2O group. The difference between the groups was significant. Conclusions: N2O insufflation of the extraperitoneal space in dogs avoided the unwanted metabolic and hemodynamic side effects of CO2 insufflation. Thus, N2O insufflation in the extraperitoneal space is a safer alternative to CO2 insufflation experimentally, and can be preferred especially in patients with cardiac and pulmonary diseases.Öğe Determining the Effect of Sufentanil on Propofol Injection Pain(KUWAIT MEDICAL ASSOC, 2012) Saritas, Tuba Berra; Borazan, Hale; Kara, Inci; Tuncer, Sema; Otelcioglu, SerefObjectives: Propofol is a general anesthetic. Its most important disadvantage is pain on injection. Our aim was to evaluate the effectiveness of sufentanil on propofol injection pain (PIP). Design: Case control randomized double-blind study Setting: Anesthesia department of Selcuk University Meram Medical School, Turkey Subjects: A total of 160 adults, 18 to 65 years, ASA I-II patients, scheduled for operations under general anesthesia, were enrolled in this study. A 22-gauge intravenous (IV) catheter was inserted into a vein on the dorsum of the hand. Patients were randomly allocated to one of four groups to receive either saline or 0.5, 1, 2 mcg sufentartil in 2 ml volume. Thirty seconds after the intravenous (IV) injection of the pretreatment drug, 5 ml of 1% propofol at room temperature (Fresenius Kabi, Hamburg, Germany) was injected IV at rate of 0.5 ml/sec. Pain was assesed verbally and scored as none (0), mild (1), moderate (2), severe (3). Interventions: Prior injection of sufentanil or placebo Main Outcome Measures: Severity of PIP Results: Demographic data were comparable among four groups. Sufentanil at 1 and 2 mcg doses significantly decreased pain incidence when compared to the saline group (p < 0.05). Sufentanil 0.5 mcg had no effect.(p > 0.05). Although 2 mcg sufentanil decreased the incidence of PIP more than 1 mcg, there was no significant difference between these groups (p > 0.05). Conclusion: Sufentanil at one and 2 mcg doses reduced the incidence and severity of PIPÖğe 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 Effects of Bupivacaine and Ropivacaine on the Isolated Human Umbilical Artery(Churchill Livingstone, 2003) Barışkaner, Hülagü; Tuncer, Sema; Taner, A.; Doğan, N.In this in vitro study on the human umbilical artery, the effects of N(omega)-nitro-L-arginine methyl ester (L-NAME), indomethacin, prazosin, yohimbine and propranolol on the responses induced by bupivacaine and ropivacaine were investigated. Arteries isolated from umbilical cords from women who did not exhibit systemic diseases, who were not on medication and who had normal full-term deliveries, were cut into spiral strips 12 x 3 mm. Strips were mounted in organ baths at 37 degreesC continuously gassed with 5% CO2 in oxygen. The responses to the drugs were recorded isometrically on a polygraph. In the bupivacaine study, when we administered cumulative concentrations of bupivacaine (10(-9)-10(-4) M; n = 6) on basal tonus, there was no relaxation or contraction response on the tissue. Strips were precontracted with serotonin (10(-6) M 5-HT) then bupivacaine (10(-9)-10(-4) M) was directly administered cumulatively. In the ropivacaine group, when cumulative concentrations of ropivacaine (10(-9)-10(-4) M; n = 6) were administered on the tissue, preconstricted with 5-HT, ropivacaine did not alter the contraction response. Ropivacaine (10(-9)-10(-4) M) was directly administered to the bath. Though bupivacaine produced relaxation, ropivacaine produced contraction (P < 0.05). Indomethacin, prazosin, yohimbine and propranolol did not significantly alter these responses. In addition, it was demonstrated that L-NAME did not affect the relaxation responses induced by bupivacaine. Thus adrenergic receptors, nitric oxide syntenaze and prostaglandins do not appear to affect the responses induced by these two local anesthetics.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 The Effects of Different Hernia Repair Methods on Postoperative Pain Medication and CRP Levels(Lippincott Williams & Wilkins, 2002) Vatansev, Celalettin ; Belviranlı, Metin; Aksoy, Faruk; Tuncer, Sema; Şahin, Mustafa; Karahan, ÖmerAlthough tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group If comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group TV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 +/- 41.6 mg/L), Lichtenstein (138.4 +/- 72.5 mg/L), and Bassini repair (137.2 +/- 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 +/- 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 +/- 189.1 mg), Bassini (303.2 +/- 173.7 mg), and Lichtenstein (253.9 +/- 129.3) procedures compared with 196.6 +/- 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures.Öğe Effects of Preoperative Oral Melatonin Medication on Postoperative Analgesia, Sleep Quality, and Sedation in Patients Undergoing Elective Prostatectomy: A Randomized Clinical Trial(Springer Tokyo, 2010) Borazan, Hale; Tuncer, Sema; Yalçın, Naime; Erol, Atilla; Otelcioğlu, ŞerefPurpose Our intention was to assess the effectiveness of preoperative oral melatonin medication on sedation, sleep quality, and postoperative analgesia in patients undergoing elective prostatectomy. Fifty-two ASA I-II patients undergoing elective prostatectomy were included in this study, randomly divided into two groups. Patients received an oral placebo (n = 26) or 6 mg melatonin (n = 26) the night before and 1 h before surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received tramadol i.v. via a PCA device. Extubation time, intraoperative fentanyl consumption, and recovery time were assessed at the end of the operation. Pain scores, tramadol consumption, and sedation scores were assessed at 1, 2, 4, 6, 12, 18, and 24 h postoperatively, and sleep quality and subjective analgesic efficacy were assessed at 24 h after surgery. There were no significant differences in demographic data between the groups. Extubation time and recovery time from anesthesia were significantly longer in the melatonin group (P < 0.05). Intraoperative fentanyl usage, pain scores, and tramadol consumption were significantly lower in the melatonin group (P < 0.05). The postoperative sleep quality of patients was significantly better in the melatonin group than in the control group (P < 0.05). Postoperative VAS of pain was significantly lower in the melatonin group compared with the control group at 1, 2, 4, 6, 12, 18, and 24 h postoperatively (P < 0.05). Subjective analgesic efficacy of patients was significantly different between groups (P < 0.05). The sedation scores were significantly higher in the melatonin group than in the control group at 1 h and 2 h after surgery (P < 0.05). Preoperative oral melatonin administration decreased pain scores and tramadol consumption and enhanced sleep quality, sedation scores, and subjective analgesic efficacy during the postoperative period.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 Epidermolizis Bulloza ve Anestezi (Olgu Sunumu)(2001) Tuncer, Sema; Tavlan, Aybars; Yosunkaya, Alper; Çiçekci, Faruk; Ökesli, SelminEpidermolizis bulloza cilt ve mukozada yaygın bililerle karakterize nadir görülen bir hastalıktır. Biz bu olgumuz nedeniyle, epidermolizis bullozanın klinik özelliklerini ve anestezi uygulamalarını gözden geçirmeyi amaçladık.Öğe Fentanyl Added to Bupivacaine 0.05% or Ropivacaine 0.05% in Patient-Controlled Epidural Analgesia in Labour(Greenwich Medical Media Ltd, 2002) Pirbudak, Lütfiye; Tuncer, Sema; Koçoğlu, Hasan; Göksu, S.; Çelik, C.Background and objective: Epidural analgesia is the most effective method for pain relief during labour. The aim was to elucidate the efficacy of ropivacaine 0.05% and bupivacaine 0.05%, which were both combined with fentanyl 0.00015% to provide analgesia in labour. Methods: Forty nulliparous females were enrolled into the study. After insertion of an epidural catheter, patients were randomly assigned into two groups. Once the os uteri had dilated to 4-5 cm, a bolus of bupivacaine 0.125% 10 mL + fentanyl 50 mug (1 mL) in Group 1 patients, and ropivacaine 0.125% 10 mL + fentanyl 50 mug (1 mL) in Group 2 patients was administered via the epidural catheter. Then, patient-controlled epidural analgesia was started with a basal infusion of bupivacaine 0.05% 10 mL h(-1) + fentanyl 0.00015% 1.5 mug mL(-1) in Group 1, and ropivacaine 0.05% + fentanyt 1.5 mug mL(-1) in Group 2. When needed, a 10 mL bolus infusion could be given and the lockout time was 20 min. Maternal and fetal haemodynamic variables were monitored before induction and subsequently at 5 min intervals. Using a visual analogue scale assessed the degree of pain. Results: Maternal haemodynamic variables and Apgar scores were not different between the two groups. The second stage of the tabour was shorter in Group 2 (P < 0.01). There were no significant differences in patients' assessment of motor block or mode of delivery between groups. Conclusions: An epidural infusion (10 mL h(-1)) of bupivacaine 0.05% or ropivacaine 0.05% together with fentanyl 1.5 μg mL(-1) provided good and safe analgesia during tabour.Öğe Guillain Barre Sendromu ve Immunoadsorbsiyon Plazmaferez (Olgu Sunumu) 2(2001) Yosunkaya, Alper; Tuncer, Sema; Tavlan, Aybars; Sarkılar, Gamze; Ökesli, SelminGuillain Barre sendromu (GBS); üst ve alt ekstremitelerde çift taraflı kas güçsüzlüğü, refleks ve değişik derecelerde sensoriyal kayıpla karakterize akut demiyelizan bir poliradikülonöropatidir. Plazmaferez, yürüyememe ve solunum yetersizliği gibi şiddetli kas güçsüzlüğü olan veya yutkunma refleksinin kaybı ve yutma güçsüzlüğü gibi diğer bulber yetersizlik bulguları gösteren CBS'li olgularda tavsiye edilmektedir. Biz bu sunumuzda; Guillain Barre sendromlu olguların tedavisinde immunoadsorbsiyon plazmaferez ve yoğun bakım servislerinde uygulanması gereken destek tedavisini tartıştık.Öğe Hemodynamic and metabolic effects of nitrous oxide and carbon dioxide insufflation in laparoscopic repair of inguinal hernias(2005) Acar, Fahrettin; Aksoy, Faruk; Belviranlı, Metin; Tuncer, SemaPurpose: The aim of this study is to compare hemodynamic and metabolic effects of CO2 and N2O insufflation into extraperitoneal area. Background: In treatment of inguinal hernia, a laparoscopic technique is widely applied to total extraperitoneal hernia (TEP) in some clinics. Due to the fact that CO2 used in the extraperitoneal area contains higher hypercarbia and acidosis compared to N2O, this leads to search for alternative gas in this area. Materials and Methods: Between September 2003 and July 2004, 24 male patients who underwent one-sided inguinal hernia operation with TEP under general standard anaesthesia, have participated in this study. We used CO2 for insufflation in 12 patients (mean age; 42±18 years) and N2O in 12 patients (mean age; 46±16 years). Prolen greft was used in both groups during repair and, throughout the operation, hemodynamic and metabolic parameters were recorded at 0, 5, 15, 30, and 45th minutes. Results: Parameters obtained from these two groups such as heart rate (HR), partial CO2 pressure (PaCO2), end-tidal CO2 pressure (PETCO2), mean arterial pressure (MAP), and total gas amount insuffleted during operation were found to be significantly higher in the CO2 group than in the N2O group (p<0,001). In contrast; pH, O2 saturation (SpO2), and partial O2 pressure (PaO2) were determined as lower in CO2 group than in N2O group throughout the operation [p<0,001]. Furthermore, visual pain score (VPS) was significantly lower in N2O group. Between the two groups, no major difference was observed in terms of endtidal N2O pressure (PETN2O). Conclusion: In the laparoscopic interventions, N2O insufflation to the extraperitoneal area does not lead to the hemodynamic and metabolic changes, whereas CO2 insufflation has detrimental effect on hemodynamic levels by causing hypercarbia and acidosis. Moreover, in the postoperation period, VPS was lower in members of the N2O insufflated group than those in the CO2 insufflated group. Consequently, in the laparoscopic surgery, during extraperitoneal inguinal hernia repairment, N2O gas has more advantage than CO2 gas.
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