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Öğe Çocuklarda Spinal Anestezi: Tek Merkezin 371 Olguluk Deneyimi(2010) Apilioğulları, Seza; Gök, Funda; Duman, AteşAmaç: Çocuklarda spinal anestezi (SA), rutin cerrahi prosedürlerden daha çok, kompleks olgularda kullanımı kabul edilmiş gibi görünmektedir. Ancak, çocuklarda SA kullanımı yetişkinlerde olduğu gibi basit, güvenli ve ekonomiktir. Bu çalışmanın amacı, çocuklarda rutin cerrahi işlemlerde spinal anestezinin etkinliği ve güvenliği ile ilgili deneyimlerimizi sunmaktır. Gereç ve Yöntem: Konya Dr. Faruk Sükan Doğum ve Çocuk Hastanesi’nde, 2007-2009 yılları arasında spinal anestezi altında ameliyat edilen 371 hastanın dosya bilgileri geriye dönük olarak incelendi. SA uygulamaları hiperbarik bupivakain kullanılarak, 27 G kalem uçlu iğne ya da 26 G keskin uçlu iğne ile gerçekleştirilmişti. Bupivakaine adjuvan olarak fentanil 0,2 ?g kg-1 ya da morfin 2 ?g kg-1 ya da her ikisi birlikte kullanılmıştı. Kayıtlardaki kişisel veriler, teknik veriler ve yan etkiler değerlendirildi. Bulgular: Hastaların yaş ortalaması 6 (1-17 yaş) idi. Hastaların % 94’ünde ilk girişimde olmak üzere başarılı SA sağlandığı saptandı. Çocukların % 26’sında operasyon sırasında ek intravenöz sedasyon gerekmişti. On hastada (% 2,7) operasyon sırasında genel anesteziye geçilmesi gerekmişti. Adjuvan olarak, 134 hastada fentanil, 50 hastada morfin, 40 hastada fentanil ve morfin birlikte kullanılmıştı. Başlıca yan etki; 3 hastada görülen bradikardi ve hipotansiyonun olmadığı yüksek düzeyde spinal bloktu (% 0,8). Ciddi nörolojik ve kardiyovasküler yan etkilere rastlanmadı. Sonuç: Hiperbarik bupivakain ile gerçekleştirilen spinal anestezi uygulamasının, uygun endikasyonu olan çocuklarda güvenilir ve kolay uygulanabilir bir anestezi yöntemi olduğu değerlendirildi. Çocuklarda intratekal 0,2 ?g kg-1 fentanil ve 2 ?g kg-1 morfin dozlarını kullanmanın uygun olduğu kanısına varıldı.Öğe The effects of 45 degree head up tilt on the lumbar puncture success rate in children undergoing spinal anesthesia(WILEY-BLACKWELL, 2008) Apılıoğulları, Seza; Duman, Ateş; Gök, Funda; Ogun, Cemile Öztin; Akıllıoğlu, İshakBackground: There are few studies for procedural techniques of lumbar puncture (LP) for spinal anesthesia in children. There are no controlled studies on the effect of patient positioning. We designed this prospective, randomized study to compare the success rates of LP of the lateral decubitus and lateral decubitus position with a 45 degree head up tilt in children undergoing spinal anesthesia. Methods: Study was conducted in 180 children aged between one month to twelve years. The LP was performed under general anesthesia using sevoflurane with a 26-gauge, atraumatic needle either in the standard lateral decubitus, knee-chest position (group I, n = 90) or lateral decubitus, knee-chest position with a 45 degree head up tilt (group II, n = 90). The free flow of clear cerebrospinal fluid (CSF) at first attempt was considered to evidence a successful LP. Results: The two groups were similar in age and weight. Total LP success rate was higher in group II than in group I (P < 0.05). When the significance between the groups was evaluated according to age, the increase in LP success rate was significant in children aged < 12 months of age but not significant in children older than 12 months of age. Conclusions: Because of higher success rate, lateral decubitus, knee-chest position with 45 degree head up tilt may be the preferred position for spinal anesthesia in infants.Öğe Efficacy of a low-dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair(WILEY-BLACKWELL PUBLISHING, INC, 2009) Apılıoğulları, Seza; Duman, Ateş; Gök, Funda; Akıllıoğlu, İshak; Çiftçi, İlhanP>Background: Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double-blinded, randomized, and placebo-controlled study to compare the efficacy of a low-dose (2 mu g center dot kg-1) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia. Methods: Fifty-four children were randomly assigned to one of two spinal anesthesia groups. Group M (n = 27) received hyperbaric bupivacaine plus 2 mu g center dot kg-1 of preservative-free morphine and group P (n = 27) received hyperbaric bupivacaine plus 0.9% NaCl (placebo) under inhalation anesthesia. General anesthetics were discontinued subsequent to the block. The primary outcome was the presence of pain-requiring analgesics during the first 12 h after the spinal block. Side effects were also recorded. The analgesic effects were evaluated by using the Children's Hospital of Eastern Ontario Pain Scale. Results: Forty-nine patients completed the trial. Fifteen patients (60%) in group P received supplementary analgesics within the first 12 h compared to only four patients (16.7%) in group M (P = 0.005). Mean duration of analgesia was 480 +/- 209 and 720 +/- 190 min in group P and group M respectively (P = 0.009). The groups were similar in postoperative side effects. Conclusion: Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 mu g center dot kg-1 intrathecal morphine provides better postoperative pain control when compared to placebo in these children.Öğe A Randomized Comparison of Dimenhydrinate, Metoclopramide and Placebo for the Prevention of Nausea and Vomiting Following Intrathecal Fentanyl and Morphine in Cesarean Delivery(Nobel Ilac, 2010) Duman, Ateş; Apilioğulları, Seza; Gök, Funda; Sütçü, Erdinç; Soysal, Sema; Toy, HarunObjective Intrathecal morphine for cesarean section provides excellent postoperative analgesia however is associated with significant nausea and vomiting This study was designed to compare the effectiveness of prophylactic use of dimenhydrinate and metoclopramide to placebo for the prevention of nausea and vomiting following intrathecal fentanyl and morphine used for cesarean section Material and Method Two hundred ten patents undergoing cesarean section under spinal anesthesia were included in this double blind and randomized study Spinal anesthesia was performed with 10 mg of hyperbaric bupivacaine combined with 20 mu g fentanyl and 200 mu g morphine After clamping the umbilical cord patients were randomly allocated to receive 50 mg dimenhydrinate intravenously (Group D) 10 mg metoclopramide (Group M) or 0 9% NaCl as placebo (Group P) The incidence of postoperative nausea or vomiting (PONV) during the first 24 postoperative hours was evaluated Results The postoperative incidence of PONV was significantly lower in Group D (11%) than in Group M (28%) and Group P (32%) (p=0 02) The incidence and severity of postoperative nausea were significantly lower with the use of dimenhydrinate as compared to metoclopramide and placebo group (p= 0 01) Conclusion The prophylactic use of dimenhydrinate (50 mg intravenously) as compared either to metoclopramide (10 mg) or placebo effectively decreased the incidence of PONV following intrathecal fentanyl and morphine for cesarean section.Öğe Spinal Needle Design and Size Affect the Incidence of Postdural Puncture Headache in Children(WILEY-BLACKWELL PUBLISHING, INC, 2010) Apilioğulları, Seza; Duman, Ateş; Gök, Funda; Akıllıoğlu, İsakBackground: In adults, pencil point spinal needles are known to be less traumatic and hence to be superior compared with cutting point needles in respect of postpuncture complications. In children, only a few trials have evaluated the difference in the incidence of postdural puncture headache (PDPH) using spinal needles with different tip designs. The aim of this study was to evaluate the success rate and the incidence of PDPH and backache following spinal anesthesia (SA) with the two types of needles currently in use for children. Methods: This is a retrospective study of prospectively collected data. The success rate and postpuncture complications of 26G cutting point (Atraucan (R)) spinal needle were compared with 27G pencil point (Pencan (R)) spinal needle in 414 children aged 2-17 years undergoing surgery with SA. Results: Both needles had similar first-attempt success rates: 87% in the cutting point group and 91% in the pencil point group (P = 0.16). Pencil point needles caused less PDPH compared to cutting point needles; 0.4% vs 4.5%, respectively (P = 0.005). Both needles caused similar backache (P = 0.08). No severe neurologic symptom was reported for both needles. Conclusion: The data suggest that 27G pencil point spinal needles lead to less PDPH compared to 26G cutting point spinal needles in children.
