Browsing by Author "Öztürk, T"
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Item Effects of High-Dose Rocuronium on the QTc Interval During Anaesthesia Induction in Patients Undergoing Coronary Artery Bypass Graft SurgeryAgdanli, D; Öztürk, T; Ütük, O; Keles, GTObjective: Existing myocardial damage in coronary artery disease patients causes prolonged QT syndrome. The primary objective of this trial is to explore the effects of different doses of the muscle relaxant agent rocuronium (0.6 mg kg-1 and 1.2 mg kg-1) on QTc following anaesthetic induction. The second objective is to determine the incidence and kinds of arrhythmias. Methods: In this prospective and randomized trial, patients undergoing elective coronary artery revascularization surgery were included in one of two groups. Both groups took the same anaesthetic induction agents: midazolam and fentanyl. Rocuronium was administered in Group 1 (n=20) with dose of 0.6 mg kg-1 and in Group 2 (n=20) with a dose of 1.2 mg kg-1 for muscle relaxation. Heart rate, average arterial pressure and QTc were recorded before induction (T0), after induction (T1), after muscle relaxant (T2), and 2 minutes (T3) and 5 minutes after intubation (T4). Results: QTc was significantly longer 2 minutes after intubation (in Group 1 and Group 2, respectively, 447.9 +/- 28.3 and 466.1 +/- 37.8 ms) than at the beginning (respectively, 426.9 +/- 25.7, 432.0 +/- 35.5 ms) (p<0.01). In the intergroup comparison, average QTc values were similar in all trial periods (p>0.05). The prevalence of arrhythmias in between Group 1 (35%, n=7) and Group 2 (15%, n=3) was similar (p=0.06). Arrhythmias were recorded 2 minutes after intubation in both groups (n=10, 25%). Conclusion: In patients undergoing coronary artery revascularization surgery, rocuronium doses of 0.6 mg kg-1 and 1.2 mg kg-1 prolong the QTc interval after intubation. Cardiac arrhythmias related to long QTc arising after intubation should be taken into consideration.Item Immune and inflammatory role of hydroxyethyl starch 130/0.4 and fluid gelatin in patients undergoing coronary surgeryÖztürk, T; Onur, E; Cerrahoglu, M; Çalgan, M; Nizamoglu, F; Çivi, MObjectives: Compare the effects on inflammatory (TNF-alpha, IL-6, IL-8 and IL-10) and immunologic (CD3(+), CD4(+), CD8(+), CD11b(+), CD16(+)/56(+) T cells and total lymphocyte concentration) variables of hydroxyethyl starch 130/0.4, 4% modified fluid gelatin, or crystalloid when used as volume replacement fluids for acute normovolemic hemodilution (a blood conservation technique) in coronary artery bypass graft patients. Methods: Thirty patients undergoing coronary artery bypass graft surgery were randomized to receive Isolyte S (R) (Group ISO), 6% hydroxyethyl starch 130/0.4 (Group HES) or 4% modified gelatin solution (Group GEL) for acute normovolemic hemodilution. Blood samples were taken immediately after induction of anaesthesia (T0), and 2 h (T1), 12 h (T2), 24 h (T3), and 48 h (T4) after separation from cardiopulmonary bypass. TNF-alpha, IL-6, IL-8 and IL-10 levels were determined with commercially available ELISA kits. CD3(+) (mature T cells), CD4(+) (T helper cells), CD8(+) (suppressor cytotoxic T cells), CD16(+)/56(+) (natural killer lymphocytes), and CD11b(+) (Mac-1, adhesion receptor) levels were measured using flow-cytometry reagents. The CD4(+):CD8(+) ratio was calculated. Results: Between-group comparisons showed significantly higher levels of TNF-alpha at T1 (2 h after weaning from cardiopulmonary bypass) in Group HES compared to Group ISO (p = 0.003). IL-8 was significantly lower in Group HES than Group GEL at T1 (p = 0.0005). IL-10 was significantly higher in Group HES than in Group GEL at T1 (p = 0.0001). The CD4(+):CD8(+) ratio in Group ISO was significantly lower than that in Group HES at T2 (p = 0.003). CD11b(+) levels in Group HES were also higher than those in Group GEL and group ISO at T2, but not significantly. CD16/56(+) levels in Group HES were higher than those in Group GEL at T2 (p < 0.003). No excessive hemorrhage occurred in any patient. Mediastinal drainage during the first 24 h after surgery in Group HES (347 +/- 207 mL) was not significantly different from that of Group GEL (272 +/- 177 mL) or Group ISO (247 +/- 109) (p > 0.05). Conclusion: Hydroxyethyl starch 130/0.4 reduced pro-inflammatory responses and increased anti-inflammatory responses to a greater degree than gelatin solution and isolyte S (R). The use of hydroxyethyl starch, compared to gelatin solution and isolyte S (R), resulted in less decrease in the CD4(+):CD8(+) ratio, suggesting less immunosuppression. (C) 2014 Elsevier Ltd. All rights reserved.Item Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgeryTopçu, I; Çivi, M; Öztürk, T; Keles, GT; Çoban, S; Yentür, EA; Okçu, GThe effects of Ringer lactate, 6% hydroxyethyl starch (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% hydroxyethyl starch 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (alpha), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the alpha angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the alpha angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, alpha angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.Item Comparison of Patient Satisfaction Between General and Spinal Anaesthesia in Emergency Caesarean DeliveriesAçikel, A; Öztürk, T; Göker, A; Hayran, GG; Keles, GTObjective: Obstetric anaesthesia aims to deliver a healthy baby as well as render a comfortable operation for the mother. This study compared general and spinal anaesthesia in terms of the quality of recovery and patient satisfaction in women undergoing emergency caesarean deliveries. Methods: In total, 100 patients were enrolled in this prospective, single-blind, cross-sectional clinical study. Patients were divided into spinal (n=50) and general (n=50) anaesthesia groups. The recovery score, pain and satisfaction were evaluated by Quality of Recovery Score (QoR-40), Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at 24 hours postoperatively. Results: The total QoR-40 scores were significantly higher and the total operation time was longer in the spinal anaesthesia group (median score: 194.5 vs. 179.0, p<0.001 and mean +/- SD: 69.0 +/- 13.3 vs. 62.7 +/- 13.4 minutes, p=0.02, respectively). There was no significant difference in VAS and NRS scores between the groups. Conclusion: Both spinal anaesthesia and general anaesthesia have advantages and disadvantages in terms of emergency caesarean deliveries. Spinal anaesthesia speeds up the recovery time and enables the mother to return to normal life earlier, while general anaesthesia has a short initiation time and does not affect patient satisfaction.Item Effects of conventional vs high-dose rocuronium on the QTc interval during anesthesia induction and intubation in patients undergoing coronary artery surgery: a randomized, double-blind, parallel trialÖztürk, T; Agdanli, D; Bayturan, Ö; Çikrikci, C; Keles, GTMyocardial ischemia, as well as the induction agents used in anesthesia, may cause corrected QT interval (QTc) prolongation. The objective of this randomized, double-blind trial was to determine the effects of high-vs conventional-dose bolus rocuronium on QTc duration and the incidence of dysrhythmias following anesthesia induction and intubation. Fifty patients about to undergo coronary artery surgery were randomly allocated to receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2 mg/kg, group H, n=25) rocuronium after induction with etomidate and fentanyl. QTc, heart rate, and mean arterial pressure were recorded before induction (T0), after induction (T1), after rocuronium (just before laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation (T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was significantly longer at T3 than at baseline [475 vs 429 ms in group C (P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc after high-dose rocuronium was not significantly longer than after conventional-dose rocuronium in patients about to undergo coronary artery surgery who were induced with etomidate and fentanyl. In both groups, compared with baseline, QTc was most prolonged at 2 min after intubation, suggesting that QTc prolongation may be due to the nociceptive stimulus of intubation.Item Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomyÖztürk, T; Topcu, I; Yaldiz, S; Özbakkaloglu, A; Asik, K; Yentür, AObjectives: In the present randomized, controlled, and blinded study, the effects of thoracic paravertebral analgesia were compared to those of epidural analgesia on postoperative pain, hemodynamics, and respiration rate following thoracotomy. Methods: Patients scheduled for elective open-lung surgery were included. One hour prior to surgery, thoracic epidural catheters were used in 18 patients (ED group), and ultrasound-guided paravertebral catheters were used in 17 patients (PV group). Standard general anesthesia was administered to all. Following anesthesia, postoperative analgesia of levobupivacaine 0.1% and morphine 0.1 mg mL(-1) was administered via catheter. Patient-controlled analgesia (PCA) regime with tramadol was initiated, and amounts of local anesthetics and tramadol demanded and delivered within the first 24 hours were recorded. Visual analog scale (VAS) pain score, sedation score, side effects, and vital signs (blood pressure, heart rate, and respiratory rate) were assessed by an observer blinded to patient data at 1, 2, 3, 4, 6, 12, and 24 hours. Results: Differences in PCA bolus demands and deliveries were not statistically significant between the PV group (26.8 +/- 1.3 and 33.1 +/- 4.5) and the ED group (25.1 +/- 3.5 and 32.5 +/- 4.3). Neither were differences in VAS scores statistically significant (p = 0.3). Rates of sedation among the PV group were lower than those of the ED group at 1 hour (p = 0.001). Five patients in the ED (% 28) group experienced hypotension (p = 0.02). Conclusion: Paravertebral block with levobupivacaine 0.1% and morphine 0.1 mg mL(-1) may be an alternative form of pain relief following thoracotomy.Item The Efficacy of Femoral Block and Unilateral Spinal Anaesthesia on Analgesia, Haemodynamics and Mobilization in Patients undergoing Endovenous Ablation in the Lower ExtremityÖztürk, T; Çevikkalp, E; Nizamoglu, F; Özbakkaloglu, A; Topcu, IObjective: This study aimed to investigate the efficacy of femoral block and unilateral spinal anaesthesia on analgesia, haemodynamics and mobilization during endovenous ablation in patients with lower extremity venous insufficiency. Methods: Forty patients of ASA physical status I and II, with ages ranging between 30 and 45 years, and who were scheduled for endovenous laser ablation for varicose veins were prospectively enrolled in this study. Patients were randomized into a unilateral spinal anaesthesia group (group HS, n=20) or a femoral block group (group F, n=20). Group HS received 7.5-10 mg of heavy bupivacaine for unilateral spinal anaesthesia, while group F received 100 mg prilocaine for femoral block with ultrasound guidance. The level of motor blockage (Bromage score), visual pain score, mean heart rate and mean arterial pressures were recorded at postoperative 0, 1, 2, 3d and 6 h, respectively. Results: Perioperative visual pain score values in both groups were <4. None of the groups required an additional analgesic agent. Bromage scores were significantly lower in group F than in group HS during the postoperative period (p<0.01). Motor function returned to normal in all patients at 3 h in group F and at 6 h in group HS. Postoperative mean heart rate and arterial pressure did not differ between the groups (p>0.05). Conclusion: In patients with lower extremity venous insufficiency who were undergoing endovenous laser ablation, an ultrasound-guided femoral block provided similar analgesia with that of unilateral spinal anaesthesia. In group F, the duration of anaesthesia and mobilization time was shorter.