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    Effect of caudal block on stress responses in children
    (BLACKWELL PUBLISHING ASIA, 2004) Tuncer, S; Yosunkaya, A; Reisli, R; Tavlan, A; Cicekci, F; Otelcioglu, S
    Background: 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.
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    Effect of gamma-hydroxybutyric acid on tissue Na+,K+-ATPase levels after experimental head trauma
    (WILEY, 2004) Yosunkaya, A; Ustun, ME; Bariskaner, H; Tavlan, A; Gurbilek, M
    Background: A failure of the Na+,K+-ATPase activity (which is essential for ion flux across the cell membranes) occurs in many pathological conditions and may lead to cell dysfunction or even cell death. By altering the concentration of specific opioid peptides, gamma-hydroxybutyric acid (GHB) may change ion flux across cell membranes and produce the 'channel arrest' which we assumed will inhibit the failure of Na+,K+-ATPase activity and therefore lead to energy conservation and cell protection. Therefore we planned this study to see the effects of GHB at two different doses on Na+,K+-ATPase activity in an experimental head trauma model. Methods: Forty New Zealand rabbits were divided equally into four groups: group I was the sham-operated group, group II (untreated group), group III received head trauma and intravenous (i.v.) 500 mg/kg GHB and group IV received head trauma and i.v. 50 mg/kg GHB. 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. The non-traumatized (left) side was named as 'a' and the traumatized (right) side as 'b'. One hour after the trauma in groups II and III and craniotomy in group I, brain cortices were resected from both sides and in group I only from the right side was the tissue Na-K-ATPase activity determined. Results: The mean +/- SD of Na+,K+-ATPase levels of each group are as follows: group I - 5.97 +/- 0.55; group IIa - 3.90 +/- 1.08; group IIb - 3.58 +/- 0.90; group IIIa - 5.53 +/- 0.60; group IIIb - 5.33 +/- 0.88; group IVa - 5.05 +/- 0.72; group IVb - 4.93 +/- 0.67. The Na+,K+-ATPase levels of group IIa, IIb, IVa and IVb were significantly different from group S (P < 0.05). There were also significant differences between group IIa and groups IIIa and IVa; group IIb and groups IIIb and IVb (P < 0.05). Conclusions: We conclude that GHB is effective in suppressing the decrease in Na+,K+-ATPase levels in brain tissue at two different dose schedules after head trauma.