Browsing by Author "Ekici N.Z."

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    The comparison of efficiency of bupivacaine-fentanyl with ropivacaine-fentanyl in patient controlled epidural analgesia for labour; [Hasta kontrollü epidural doǧum analjezisi için bupivakain fentanil ile ropivakain fentanilin etkinliǧinin karşilaştirilmasi]
    (2004) Topçu I.; Yentür E.A.; Tekin S.; Çavuş Z.; Ekici N.Z.; Sakarya M.
    In this prospective, randomized, double-blinded study we aimed to evaluate the efficiency of 1μg mL-1 fentanyl with 0.125% bupivacaine and 1μg mL-1 fentanyl with 0.125% ropivacaine by patient controlled epidural analgesia (PCEA) for labour. The study was performed in 2 groups; each consisted of 20 pregnants which had healthy, single fetus in 36-41 gestational weeks with normal fetal pulse pattern in vertex position, 3-6 cm of cervical dilatation and at active phase of labour. Solution of 1μg mL-1 fentanyl with 0.125% ropivacaine was applied to Group I and 1μg mL-1 fentanyl with 0.125% bupivacaine to Group II. PCEA was programmed as 5 ml bolus dose, 10 minutes lock-out (without basal infusion, and 1-4 h limit) and 10 mL loading dose. Patients' pain was evaluated by VAS (visual analog scale) (0-100mm), sensory block by PinPrick test (0-3) and motor block by modified Bromage scale. Maternal mean arterial pressure (MAP), heart rate (HR) and fetal HR were recorded during the labour. Umblical artery blood pH, APGAR of fetus and patient satisfaction after delivery (1-5) were assessed. Mode of delivery (normal, operative and cesarean), side-effects, duration of labour and analgesics consumption for the first and second stages of labour were recorded by calculating the values via PCEA. No differences were obtained in the evaluation of MAP, HR, fetal HR, VAS, sensory block, amount of analgesics solution, mode of delivery, duration of labour, side effects and patient satisfaction between the groups. However, lesser motor block was observed in ropivacaine/fentanyl group rather than bupivacaine/fentanyl group (p<0.05). Consequently, both 1μg mL-1 fentanyl with 0.125% ropivacaine and 1μg mL-1 fentanyl with 0.125% bupivacaine by patient controlled epidural analgesia (PCEA) for labour, provided sufficient and trustworthy analgesia. Similar effects were obtained on hemodynamics but because of lesser motor block effect, we propose that ropivacaine more superior for labour analgesia.
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    Seizures, metabolic acidosis and coma resulting from acute isoniazid intoxication
    (Australian Society of Anaesthetists, 2005) Topcu I.; Yentur E.A.; Kefi A.; Ekici N.Z.; Sakarya M.
    Isoniazid is an anti-tuberculosis drug, used commonly for treatment and prophylaxis of tuberculosis. Acute isoniazid intoxication is characterized by a clinical triad consisting of metabolic acidosis resistant to treatment with sodium bicarbonate, seizures which may be fatal and refractory to standard anticonvulsant therapy, and coma. Treatment requires admission to the intensive care unitfor ventilatory support, management of seizures and metabolic acidosis. Pyridoxine, in a dose equivalent to the amount of isoniazid ingested, is the only effective antidote. We report the successful treatment of two isoniazid intoxication cases: the case of a child developing an accidental acute isoniazid intoxication and an adult case of isoniazid intoxication with the intent of suicide.
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    Retrospective clinical evaluation of intoxication cases requiring critical care treatment; [Yoǧun Bakim Tedavisi Gerektiren Zehirlenme Olgularinin Retrospektif Olarak Deǧerlendirilmesi]
    (2005) Topçu I.; Sakarya M.; Çetinkaya B.; Taşyüz T.; Ekici N.Z.
    The purpose of this study was to analyze the intoxication cases requiring critical care treatment and to evaluate the prognosis using an objective clinical scoring system: APACHE II "Acute Physiology and Chronic Health Evaluation Scoring System". Between 1999 and 2003, 165 ICU patients, were evaluated retrospectively according to demographic data, route of intoxication, intoxicating material and the reason for intoxication, in order to estimate the prognosis and clinical course. The mean age of patients was 28.8. Of the poisoning cases, 39.4% were male and 60.6% were female patients. According to the distribution of occupations, the incidence was obtained as 29.1% housewife and student, 12.1% unemployed, 8.5% self-employed, 6.1% soldiers, 3.6% farmer and 13.9% the others. Intoxications were 88.5% oral and 10.3% by inhalation. 69.1% of the causes for intoxication were suicidal intent, 27.9% accidental and 3% overdose. 97.6% of the cases recovered and were discharged, while 2.4% died. There is a correlation between the length of stay in the ICU and mortality with the APACHE II score (p<0.05). As a result, APACHE II scores may be used to evaluate the severity of the case in order to estimate the prognosis in acute intoxication cases requiring critical care treatment.
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    The effects of tramadol and fentanyl on gastrointestinal motility in septic rats
    (Lippincott Williams and Wilkins, 2006) Topcu I.; Ekici N.Z.; Isik R.; Sakarya M.
    In this study, we investigated the effects of tramadol and fentanyl on gastrointestinal transit (GIT) during acute systemic inflammation in an experimental model of cecal ligation and perforation (CLP). One-hundred-twenty male Swiss-Albino rats were divided randomly into 6 groups: Group I = sham-operated + saline; Group II = sham-operated + fentanyl; Group III = sham-operated + tramadol; Group IV = CLP + saline; Group V = CLP + fentanyl; Group VI = CLP + tramadol. Suspension of charcoal was administered as an intragastric meal to measure the GIT. GIT% (mean ± SD) were 46.1% ± 9.8%, 43.2% ± 9.8%, 45.9% ± 10.2%, 33.2% ± 9.2%, 24.9% ± 4.1%, and 31.8% ± 8.4% in Groups I, II, III, IV, V, and VI, respectively. GIT% was significantly less in Group V than in Groups I, II, III, and IV (P < 0.05). The Group VI mean value was significantly lower than those of Groups I, II, and III (P < 0.05) but not different from those of Groups IV and V (P > 0.05). The antitransit effect of fentanyl was shown to have increased in the experimental sepsis model, but no decrease in GIT was obtained with tramadol. This was thought to be the result of an associated endogenic opioid system activation and receptor upregulation in sepsis. ©2006 by the International Anesthesia Research Society.
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    Comparison of preoperative tests for predicting difficult endotracheal intubation; [Zor endotrakeal entübasyonun tahmininde preoperatif testlerin etkinliǧinin karşilaştirilmasi]
    (2006) Sabanci Ü.; Topçu I.; Tekin S.; Ekici N.Z.; Lüleci N.
    Aim: Many different teats were proposed preoperatively to predict difficult endotracheal intubations. In this prospective study, we aimed to assess the effectiveness of the tests for predicting difficult intubation. Materials and Methods: 603 adult patients (238 male, 365 female) submitted for elective surgery under general anesthesia were included in this study. Age, height, weight, interincisor gap, neck circumference, sternomental and thyromental distance were recorded during prcoperative evaluation. Wilson risk score, modified Mallampati classification, head-neck movement, mandibular protrusion, history of difficult laryngoscopy or intubation and anatomic anomalies were also noted. Cormack and Lehane classification was used for visualization of the larynx. The number and duration of attempts at each tracheal intubation were recorded. Results: Tracheal intubations were difficult to perform in 25 (4.1%) patients. There was not any significant correlation between the difficult intubation and weight, thyromental and sternomental distances, mandibular protrusion and limited neck extension of the patients (p>0.05). Difficult intubations had significant association with increased age, male sex, two and more Wilson's risk score, mean interincisor gap and neck circumference, increased Mallampati score, Cormack-Lehane Grade 3 or 4 and decreased mouth opening (p<0.05). <2 cm interincisor gap had high (99 %) specificity. Also sensitivity of Cormack-Lehane Grade 3 or 4 was found higher (71%) than other parameters. Concluions: Cormack and Lehane classification is the most valuable test for predicting difficult intubation. Therefore laringoscopic view must be evaluated well and suitable position for the patient must be obtained. The highest specificity (99.8%) and positive predictive value (50%) belongs to <2 cm interincisor gap in our patients as a preoperative test. Not all but some of the preoperative tents have significant predictive value for difficult intubation.
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    Comparison of analgesic activity of the addition to neostigmine and fentanyl to bupivacaine in postoperative epidural analgesia
    (2006) Tekin S.; Topcu I.; Ekici N.Z.; Caglar H.; Erincler T.
    Objectives: To compare the analgesic and side effects of bupivacaine in combinations with neostigmine and fentanyl using patient-controlled-epidural analgesia (PCEA) methods in the postoperative period after abdominal hysterectomy. Methods: Seventy-five adult American Society of Anesthesiologists physical status I-II patients, aged 18-65 years were included in the study. The study took place in Celal Bayar University Hospital, Turkey between 2003-2004 years. After preoperative epidural catheterization, the patients were operated under general anesthesia. After surgery, the patients were randomly allocated in a double-blinded manner to receive PCEA and divided into 3 groups: Group B: 0.125% bupivacaine, Group N: 0.125% bupivacaine plus neostigmine 4 μg kg-1 and Group F: 0.125% bupivacaine plus 1 μg kg-1 fentanyl solutions (10 mL loading dose, 5 mL bolus dose, 10 min lockout time, 30 mL in 4 hour limit). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale, total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated. Results: Total analgesic consumption was 143.7 ± 7.2 mL in Group B, 123.4 ± 6.2 mL in Group N and 106 ± 8.3 mL in Groups F. The mean value in Group F was significantly lower than Group N and Group B (p<0.05), and was lower in Group N than Group B. Visual analog scale scores were lower in Group F than other groups (p<0.05). There were no differences in side effects between all groups. Conclusions: Fentanyl and neostigmine by the PCEA method can be used safely for postoperative analgesia after gynecologic surgery. They increase analgesia quality and satisfaction without an increase in side effects.