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Öğe Comparison of alfentanil and remifentanil at total intravenous anesthesia in short-term elective surgery [Kisa süreli cerrahi girişimlerde alfentanil ve re?ifentanilin tiva'da karşilaştirilmasi](2002) Özel M.; Yosunkaya A.; Tavlan A.; Reisli R.; Ökesli S.In our study, adding alfentanil as an opioid analgesic to propofol for total intravenous anesthesia in short-term elective surgery was compared to remifentanil. We aimed to study the anesthesia induction, maintenance and recovery characteristics of the two drugs. This study was carried out on 50 patients in ASA I-II group. They were between the ages of 18-60 and they were planned to be discharged from the hospital in 1-2 days. They were randomised into two groups, 20 ?g kg-1 alfentanil was given to group I and 1 ?g kg-1 remifentanil iv to group II patients as bolus injection, 2 ?g kg-1 min-1 alfentanil and 0.5 ?g kg-1 min-1 remifentanil iv infusion was also started respectively. Following this, these two group of patients were intubated by applying 2 mg kg-1 propofol+0.15 mg kg-1 vecuronium iv bolus and 90 ?g kg-1 min-1 iv propofol infusion. Alfentanil and remifentanil infusions were halfened 5 min after tracheal intubation and propofol infusion was decreased to 60 ?g kg-1 min-1 30 min after beginning. All patients were vetilated with 100 % O2 during the operation. Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure and heart rate measurements were recorded before anesthesia, 1, 3, 5 min after remifentanil or alfentanil application, after the intubation and skin incision, and during surgery every 10. min. The haemodynamic and somatic responses to intubation-skin incision and surgical stimulation were identified. After operation, recovery time and adverse events were recorded. The response to tracheal intubation and skin incision was less in remifentanil group than in alfentanil group, statistically considerable difference was not identified. No differences were compared in the evaluation of times, seeing reponse to surgical. A smaller proportion of remifentanil patients than alfentanil patients had required addition opioid doses during maintenance (p < 0.05). When comparing the recovery period of each group, it was significantly shorter in the remifentanil group than in the alfentanil group (p < 0.05). These two groups were similar in the aspect of observing postoperative adverse events. As a result, we think that remifentanil can be prefered to alfentanil as an addition opioid agent in TIVA which is applied for short-term surgical procedures because a smaller remifentanil patients require a study opioid adjustments needed to treat light anesthesia responses and remifentanil provides rapid recovery.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 Effects of magnesium sulfate on Na+,K+ -ATPase and intracranial pressure level after cerebral ischemia(2004) Ustun M.E.; Bariskaner H.; Yosunkaya A.; Gurbilek M.; Dogan N.In the present study, the effects of magnesium sulfate on Na +,K+-ATPase levels and intracranial pressure (ICP) after cerebral ischemia in rabbits were studied. Thirty New Zealand rabbits were divided into three groups. Group 1 was the control group. In group 2 (untreated group) cerebral ischemia was produced by clamping bilateral common carotid arteries for 60 min but in group 3 magnesium sulfate was administered 100 mg/kg i.v. 10 min after opening the clamps. In group 1, ICP recordings were obtained 5, 60 and 120 min after craniectomy. In groups 2 and 3, ICP recordings were obtained 5 min after craniectomy but before clamping, 60 min after clamping and 60 min after opening the clamps. After taking ICP recordings, brain cortices were resected and Na+,K+-ATPase activity was determined by subtracting the enzyme activity in the presence of ouabain from the total activity in the absence of ouabain method. There was a significant difference between Na+,K+-ATPase levels of group 1 and group 2 (P < 0.05). There was no significant difference in Na+,K +-ATPase levels between group 1 and 3 (P > 0.05), also preischemic ICP values were same in all groups (P > 0.05). Preischemic and postischemic ICP values were significantly different between groups 1 and 2 (P < 0.05), also postischemic (120 min) ICP values were significantly different between group 2 and group 3 (P < 0.05). ICP values correlate well with Na +,K+-ATPase level. These results demonstrate that cerebral ischemia leads to a decrease of ATPase level in the brain and magnesium sulfate suppresses the decrease of Na+,K+-ATPase, also magnesium sulfate treatment improves the ICP changes.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 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 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.
