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Öğe Comparison of Different Doses of Sufentanil for Control of Hemodynamic Response to Tracheal Intubation [trakeal Entübasyonda Oluşan Hemodinamik Yanitin Kontrolünde Sufentanilin Farkli Dozlarinin Karşilaştirilmasi](2003) Tuncer S.; Reisli, Ruhiye; Yosunkaya, Alper; Tavlan, Aybars; Uzun S.; Ökesli S.In our study, we aimed to determine the most appropriate, sufficient, and safe dose of sufentanil in the hemodynamic response to laringoscopy and intubation. This study was performed on 45 ASA I-II physical status, without cardiovascular illness, normotansive patients planned for elective surgery. Patients were randomized into three equal groups. All patients received an intravenous midazolam premedication (0.03 mg kg-1. Ten minutes after, 0,1 ?g kg-1 sufentanil in Group I (GI), 0.15 ?g kg-1 sufentanil in Group II (GII) and 0.2 ?g kg-1 sufentanil in Group III (GIII) were administrated intravenously. About two minutes after, all patients received 2 mg kg-1 propofol and 1.5 mg k-1 succinylcholine. The patients were intubated under direct laringoscopy. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and heat rate (HR) were measured: at the beginning (10 min. qfter midazolam applicati-on) (tO), before propofol (tl), before laryngoscopy (t2), 1 and 3 minutes after the tracheal intubation (t3,t4). When the group parameter values were evaluated, it was observed that there was an significant increase in HR after the intubation (t3,t4) in G I (p>0.05). In G II SAP was significantly decrease after induction (t2) when compared with tO (p<0.05). All hemodyaamic parameter values (SAP, DAP, MAP, HR) were found significantly decrease at t2, t3, t4 in G III (p<0.05). When the groups were compared, there were no differences in all measurement times in the aspect of hemodynamic parameter values between G I and G IIH (p>0.05). SAP, MAP, HR values at t3 and SAP, DAP, MAP, HR at t4 were found significantly lower in G III than in G I (p<0.05) and HR values at t3, t4 were found significantly lower in G III than G II (p<0.05). Bradycardia occurred in seven patients in G III. As a result; We think that 0.15 ?g kg-1 sufentanil was safe and satisfactory to suppress the response after laryngoscopy and tracheal intubation in healthy normotensive patients without cardiovascular disease.Öğe 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.Öğe 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.Öğe The effects of intravenous dexketoprofen on postoperative analgesia and morphine consumption in patients undergoing abdominal hysterectomy [Abdominal histerektomi uygulanan olgularda intravenöz deksketoprofenin postoperatif analjezi ve morfin tüketimine etkisi](2010) Tuncer S.; Reisli R.; Keçecio?lu M.; Erol A.Objectives: Dexketoprofen trometamol is a water-soluble salt of the dextrorotatory enantiomer of the nonsteroidal anti-inflammatory drug ketoprofen. The aim of this study was to investigate the effect of intravenous dexketoprofen on postoperative pain. Methods: This study was performed on 50 (ASA I-II) patients scheduled for abdominal hysterectomy. Fifty patients were randomized into two equal groups. Patients received saline solution (Group I) or 50 mg intravenous dexketoprofen (Group II) 1 hour (h) before surgery and 8-16 h after surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received intravenous (IV) morphine via a PCA (patient- controlled analgesia) device. Pain scores were assessed at 2, 6,12 and 24 h after surgery. Morphine consumption and adverse effects were noted during the first 24 h after the surgery. The pain scores were significantly lower in the dexketoprofen group compared with the control group (p<0.05). Results: The cumulative morphine consumption was also lower in the dexketoprofen group than the control group (p<0.05). No significant difference was observed in adverse effects between the groups (p>0.05). Conclusion: We conclude that the administration of IV dexketoprofen provided a significant analgesic benefit and decreased the morphine requirements in patients undergoing abdominal hysterectomy.Öğe The effects of intravenous paracetamol on postoperative analgesia and tramadol consumption in cesarean operations [Sezaryen cerrahisinde intravenöz parasetamolün postoperatif analjezi ve tramadol tüketimine etkisi](2010) Kiliçaslan A.; Tuncer S.; Yüceaktaş A.; Uyar M.; Reisli R.Objectives: In this study, the effects and side effects of intravenous paracetamol application, combined with patient-controlled intravenous tramadol analgesia, were investigated in elective cesarean operations for postoperative pain control and its tramadol-sparing effect. Methods: Fifty ASA I-II patients scheduled for cesarean operation were enrolled in this study. Patients were randomly divided into two groups: group I served as a control group, with saline administration (100 ml) 15 min before the end surgery and every 6 h for 24 h, whereas group II received paracetamol (1 g/100 ml) at the stated time points. All patients received a standard anesthetic protocol. At the end of surgery, all patients received tramadol i.v. via a PCA (patient-controlled analgesia) device. Pain and sedation scores were assessed at 1, 3, 6, 12 and 24 h postoperatively. Results: Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. The pain scores were significantly lower in the paracetamol group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the paracetamol group than the control group (p<0.05). No significant difference was observed in sedation scores and nausea-vomiting scores between the groups (p>0.05). Conclusion: We conclude that paracetamol is a safe and effective treatment option in post-cesarean pain for combination with tramadol, as it produces effective analgesia and reduces tramadol consumption.Öğe The effects of preemptive dexketoprofen use on postoperative pain relief and prmadol consumption [Preemptif deksketoprofen kullaniminin postoperatif a?ri ve tramadol tüketimine etkisi](2011) Kaka I.; Tuncer S.; Erol A.; Reisli R.Onjectives: In this study, the efficacy of preemptive dexketoprofen usage on postoperative pain relief and tramadol consumpation was evaluated. Methods: Fifty American Socity of Anestbesiologists(ASA)-I or ASA-II patients undergong plastic surgery were randomized into two groups. Groups. 1 received dexketoprofen 25 mg and Group 2 received placebo tablets 1 hour (h) before surgery. All patients received a standard anesthetic protocol. At the end of the surgery, all patients received intravenous tramadol with Patient Controlled Analgesia (PCA) device. Pain scores was evaluated with visual analog scale during the postoperative 1st, 8th and 24th h. Tramadol consumption, adverse effects and patient satisfaction were recorded. Results: The pain scores and tramadol consumption were significantly lower in Group 1 (p<0.05). Nausea and vomiting were observed more in Group 2 than Group 1, and patient satisfaction was better in Group 1 (p<0.05). Conclusion: Preemptive use of dexketoprofen reduced postoperative tramadol consumption and incidence of adverse events.Öğe The effects of sufentanil and remifentanil in the isolated perfused rat kidney [Sufentanil ve remifentanilin izole perfüze rat böbre?i üzerine etkileri](2004) Tuncer S.; Barişkaner H.; Yosunkaya A.; Kiliç M.; Do?an N.; Otelcio?lu Ş.In this study, the effects of indomethacin (prostaglandin synthase inhibitor), propranolol (beta adrenergic receptors blocker), tetraethylammonium (TEA) (calcium-dependent potassium channel blocker) and glibenclamide (ATP-sensitive potassium channel blocker), NG nitro-L-arginine (NO synthetase inhibitor) and naloxame (nonselective opioid receptor antagonists) on the responses induced by sufentanil and remifentanil were investigated in the isolated perfused rat kidney. Renal arter was cannulated. Then the kidney was perfused continueously with warmed (37 °C) and aerated (95% O 2 and 5% CO 2). Krebs Henselieit solution by using a peristaltic pump delivering a constat flow (8-10 ml/min). Vascular responses were detected as changes in perfussion pressure, which was monitored continuously with a pressure transuder and recorded on polygraph. After phenilephrine (PE)-induced vasoconstriction had reached a platoe, sufentanil or remifentanil were given. Vasodilatation was recorded. Antagonists or inhibitors were added and responses were recorded. At the end of each experiment; papaverine was used to obtain the maximum dilatation. None of the used antagonists or inhibitors were not effected the submaximum PE construction. The used opioids were not alter in basal perfusion pressure. Antagonists or inhibitors had no effect on papaverine-induced dilatation. Bolus addition of sufentanil and remifentanil produced concentration dependent vasodilation. Indomethacine L-NAME, propranolol, naloxone and glibenclamide did not significantly alter responses of both of the opioids (p>0.05). But, sufentanil and remifentanil induced dilatation were significantly affected by TEA (p<0.05). The present results demonstrated that sufentanil and remifentanil decrease perfusion pressure in the isolated rat kidney and such mechanism may involve the calcium actived K + channels activation.Öğe The effects of the administration of suhfacial levohupivacaine infusion with the ON-Q pain pump system on postoperative analgesia and tramadol consumption in cesarean operations [Sezaryen cerrahisinde on-q a?ri pompa sistemi ile uygulanan subfasiyal levobupivakain infüzyonunun postoperatif analjezi ve tramadol tüketimine etkisi](2010) Tuncer S.; Aysolmaz G.; Reisli R.; Erol A.; Yalçin N.; Yosunkaya A.Objectives: In this study, the effects of administration of suhfacial levobupivacaine infusion with the ON-Q pain pump system were investigated in elective cesarean operations for postoperative pain control and tramadol-sparing effect. Methods: Fifty ASA I-II patients scheduled for cesarean operation were enrolled into this study. Patients were randomly divided into two groups: Group I served as a control group, without the ON-Q pain pump system, whereas Group II received the ON-Q pain pump system with subfacial 0.25% levobupivacaine infusion for 24 hours at 4 ml/hour. All patients received a standard anesthetic protocol At the end of the surgery, all patients received tramadol i.v. via a PCA (Patient Controlled Analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 hours postoperatively. Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. Results: The pain scores were significantly lower in the levobupivacaine group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the levobupivacaine group than in the control group (p<0.05). Group II used less antiemetic and had less postoperative nausea and vomiting and the difference was statistically significant (p<0.0S). Conclusion: No complication occurred as a result of the ON-Q pain pump system. Subfacial levobupivacaine infusion with the ON-Q pain pump system diminished postoperative pain and the need for tramadol use following cesarean operations.Öğe Evaluation of the knowledge and attitude of obstetric patients on epidural analgesia [Epidural analjezi konusunda obstetrik hastalarin bilgi ve davranişlarinin de?erlendirilmesi](2004) Pirbudak L.; Balat Ö.; Tuncer S.; Öner Ü.Epidural analgesia (EA) is one of the most commonly used techniques in obstetric analgesia. Our objective was to evaluate patients who experienced EA during labour as well as to find out their knowledge, attitude and behaviour in this matter, prospectively. Between 1997 and 2002, a questionnaire, "patient evaluation form for EA", was delivered to 190 obstetric patients. The patients were divided into two groups. In Group I there were 100 patients who were evaluated between 1997 and 1999, and Group II was comprised of 90 patients who were evaluated between 2000 and 2002. Demographic data of the patients were similar in both groups. The question "How have you been informed about EA?" was replied as "TV or newspaper" by 50% of the patients in Group I while the answer was "from someone who experienced it before" by 60% of the patients in Group II (p<0.01). With these information about EA, 30% and 40% of the patients in Group I were found out to be worried about neural paralysis and some possible disorders related to their babies, respectively. However, 40% of the patients in Grup II worried about back pain and headache (p<0.01). As a result, considering the mother candidates' high information rate from someone who experienced EA before (60%), interest to the labour analgesia will increase as the mothers are satisfied with the results of EA.Öğe Gabapentin for neurophatic pain in children: A case report [Nöropatik a?rili bir çocukta gabapentin kullanimi: Olgu sunumu](2008) Dayio?lu M.; Tuncer S.; Reisli R.Gabapentin is used as an analgesic in neuropathic pain. In this report a children with nerophatic pain because of mercury poising was followed-up for pain and side effects with the use of gabapentin. Pain reduction was good throughout the patient treatment. Severe side effects did not occur. Gabapentin was effective and well tolerated in the treatment of neuropathic pain in children.Öğe Systemic effects of epidural betamethasone injection(2004) Tuncer S.; Barişkaner H.; Yosunkaya A.; Reisli R.; Ökesli S.A single epidural injection of a steroid may produce a suppression of the adrenocortical secretion. We aimed to evaluate systemic effects of a single epidural injection of betamethasone in this study. The study included 33 patients with low back pain. None of the patients had received local or systemic steroid therapy within 2 months before the injection. The epidural injection consisted of 10 mg of betamethasone diluted in 8 ml 0.25% bupivacaine. Injections were performed between 8:00 and 9:00 a.m. Before the injection in the same day (D0) cortisol, ACTH, fasting levels of glucose, triglycerides, cholesterol, sodium, and potassium were checked in the blood. The same assays were done again by the same laboratory at 15, 30, 45 min, and 7 (D7) and 21 (D21) days after the steroid injections. In all patients, cortisol and ACTH were normal at D0. ACTH and cortisol significantly decreased 45 min and at D7 after steroid injection, but returned to normal on D21. There were no significant changes in mean fasting glucose, sodium, potassium, triglycerides or cholesterol levels during the study. Blood pressure values were normal in all patients. As a result, it is concluded that a single epidural injection of betamethasone is associated with transient adrenal suppression.Öğe Transdermal fentanyl for neuropathic pain: A case report [Nöropatik a?rida transdermal fentanil kullanimi: Olgu sunumu](2006) Tuncer S.; Reisli R.; Kara I.; Otelcio?lu Ş.The mechanisms responsible for neuropathic pain are not fully understood. Most treatment modalities are ineffective or insufficient for this important clinical condition. Better understanding of pain mechanisms and opioid drug action has widened the indications for opioids in pain therapy of non-malignant pain including neurophatic pain. In this report of a female patient with chronic non-malignant neurophatic pain was followed-up for pain and side effects, for approximately fourteen months with the use of transdermal fentanyl (TDF). Pain reduction was good throughout the study. Severe side effects did not occur. TDF was effective and well tolerated in the treatment of chronic neuropathic pain of non-malignant origin.Öğe The usage of tramadol hydrochloride in intraoperative and early postoperative analgesia [Intraoperatif ve erken postoperatif analjezide tramadol hidroklorid kullanimi](1999) Tuncer S.; Bariskaner H.; Aydemir T.; Yosunkaya A.; Otelcioglu S.Tramadol hydrochlorid (TH), a synthetic opioid, is an efficient analgesic. But there are various views on its usage in anaesthesia. In this study, the efficiency of TH in intraoperative and early postoperative analgesia, its effect to hemodynamic parameters and its side effects were studied. Premedication with 10 mg diazepam, 0.5 mg atropine was applied to 20 cases from the group of ASA I-II which would undergo elective gynaecological laporoscopic surgery. Anaesthesia induction was provided by 5 mg/kg thiopental, 1.5 mg/kg TH and 1.5 mg/kg sucsynilcholine and also continuation was provided by 2-2.5 % sevoflurane. Atracurium was added when necessary. When insufficient anaesthesia symptoms were seen. 25 mg. TH was added. With the aim of postoperative analgesia, 1.5 mg/kg TH was applied to the cases in the waking up room. As a result, when TH is added to anaesthesia, it can be tolerated very well in the depth of anaesthesia and providing sufficient analgesia and we believe that it will be used safely due to its minimal side effects and the immediate recovery it provides, especially in daily surgery.
