Browsing by Author "Erincler T."
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Item The effect of tramadol on minimal alveolar enflurane concentrations in children; [TRAMADOL'UN COCUKLARDA MINIMAL ALVEOLER ENFLURAN KONSANTRASYONLARINA ETKISI](1996) Erincler T.Laryngospasm following extubation can be quite troublesome after adenoidectomy and tonsillectomy for children. High end-tidal anesthetic concentrations may prevent the anesthetized patients from coughing or moving during and immediately after tracheal extubation, but extubating while the child is quite deeply anesthetized is uncommon in current practice. In this study it has been proved that tramadol given intravenously at a dose of 2 mg/kg following extubation is quite effective in preventing laryngospasm in children after adenoidectomy, and does not cause respiratory depression. Eighty-seven children undergoing adenoidectomy and myringotomy were divided randomly into two groups consisting of 33 and 54 children. Tramadol was given intravenously after the induction of anesthesia to the larger group. Anesthesia was maintained with enflurane, nitrous oxide and oxygen in both groups. End-tidal enflurane concentrations were sampled from a -T- piece attached to the endotracheal tube and measured continuously by mass spectrometry. Oxygen saturations were monitored by pulse oximetry. The minimum alveolar concentrations of enflurane for satisfactory tracheal extubation were found to be 1.9 ± 0.5% and 0.8 ± 0.4% in group I and group II children, respectively. In anesthetized children between ages 2 and 9, tracheal extubation may be accomplished without coughing, laryngospasm or respiratory depression with smaller end-tidal enflurane concentrations, if tramadol is administered previously.Item Anaesthetic quality in children during inhalational induction and anaesthesia with sevoflurane or halothane; [COCUKLARDA SEVOFLURAN ILE HALOTANIN ANESTEZI KALITESI YONUNDEN KARSILASTIRILMASI](1997) Erincler T.; Luleci N.; Gul R.; Erbuyun K.; Tutan A.Due to its low blood gas partition coefficient (0.69) and its neutral odor, sevoflurane (S) is suitable for inhalational induction of anaesthesia. At the moment halothane (H) is preferentially used for this purpose due to its non-irritating odor and the smoothness of anaesthetic action. However, experience is limited with the use of S in children. Therefore, we compared S and H in an open, randomized trial. 40 children (age 1-10, mean, 5.3 years, ASA class I and II) had anaesthesia induced without premedication (fresh gas flow 6 L/min, N2O/O2=65/35). Concentration of volatile anaesthetics was increased ever 3-5 breats (S: % 0.8....3.2 vol, H: % 0.4....1.6 vol). The ciliary reflex was tested until it disappeared. Airway reflexes and excitation were quantified using a score. Upon venipuncture, relaxation and intubation, anaesthesia was maintained with S (Fi: % 1.8 vol) or H (Fi: % 0.9 vol) in N2O/O2 (3 L/min) E(T)CO2 35-38 mmHg). Alfentanyl was supplemented in repeated doses of 10 μg/kg, ECG, NIBP, SpO2, Fi and Fet of CO2 and volatile anaesthetics were continuously recorded. At the end of surgery anaesthetics were terminated abruptly and fresh gas flow was increased to 6 L/min O2. Time to the first purposeful movement was registered. Time to possible discharge from the PACU was quantified using a modified Aldrete score. Data were analysed with 'Student's t' test or non-parametric tests as appropriate. Groups did not differ with respect to age, weight, sex, or type of surgery. It's concluded that sevoflurane is an alternative to halothane in pediatric inhalational anaesthesia, with a comparable, low incidence of airway irritation and smoothness of induction. Because of the significantly faster induction and recovery it seems superior to halothane.Item The addition of metoclopramide to the PCA with tramadol; [Tramadol ile yapilan PCA'ya metoklopramid eklenmesi](1998) Luleci N.; Erincler T.; Tekin I.; Gumus B.; Erbuyun K.; Tutan A.Nausea and vomiting is a major problem during opioid administrations. In PCA (Patient Controlled Analgesia), sufficient analgesia can be obtained with smaller doses of opioids but nause and vomiting may still a great problem. Addition of antiemetics to opioids in PCA applications is not studied adequately. In this study we added metoclopramide to tramadol hydrochloride (TH) TH for PCA and evaluated its effects on the nausea and vomiting. 36 patients in ASA I-III, were allocated randomly into two groups (each had 18 patients) to receive patient-controlled analgesia with either TH and metoclopramide combination or with TH alone. Bolus doses of TH 20 mg (limited to 200 mg in four hours) alone used in the first and combined with metoclopramide 5 mg in the second group were used with a lockout time of 15 min. During the first 24 h. after surgery the VAS scores and side effects were recorded. The patients in metoclopramide group have significantly lower PAC scores (p<0.05). As a result nausea and vomiting can be reduced by addition of metoclopramide to TH in PCA. The same method maybe used also with of other opioids.Item Effects of different midazolam doses for rectal premedication in children; [Cocuklarda rektal premedikasyonda farkli midazolam dozlarinin etkileri](1998) Erincler T.; Luleci N.; Tutan A.In this study the efficacy of rectally administered midazolam in different doses for premedication of anaesthesia in pediatric patients have been evaluated. 42 children ages one to 10 years, scheduled for adenotonsilectomies in the ENT surgery ASA physical status I or II participated in the study. They were divided randomly into four groups, 11, 10, 10 and 11 in each group. The groups received 0.3, 0.4, 0.5 and 0.6 mg/kg midazolam respectively. Children in the second and third groups had a significantly higher percentage of excellent induction compared with the children in first group. The children in the first group (0.3 mg/kg) had significantly shorter length of stay in recovery room. Children in the 3th and 4th groups had a significantly lower incidence of postoperative excitement than first group (p<0.05). The highest incidence of marked sleepness and depression postoperatively was in the fourth group (p<0.01). Overall satisfactory premedication ratings were 54.3%, 90%, and 96.7% in the first, second, and third groups respectively. In our opinion more satisfaction can be obtained with rectally administered 0.5 mg/kg midazolam premedication in children.Item A comparison of two sedation methods for elective cataract surgery; [Katarakt cerrahisinde lokal anestezi oncesinde iki farkli sedasyon yonteminin karsilastirilmasi](1998) Tekin I.; Ozturk F.; Erincler T.; Luleci N.; Alincak H.; Kurt E.; Inan U.The aim of this study was; to compare two different ways of sedation for elective cataract surgery. 30 patients (in ASA I-II-III classes and 18-65 years old), undergoing to elective cataract surgery were divided in two groups, each of them consisted from 15 patients. In group I sedation was performed with 1 mg/kg propofol IV and in the second group with a combination of 0.07 mg/kg droperidol and 1 μg/kg fentanil IV. Intraocular pressure (IOP) was measured; heart rate (HR), mean arterial blood pressure (MAP), SpO2, respiratory rate (RR) and sedation scores (SS) were noted before (T1), 5 minutes after sedation (T2), and at the end of the operation (T3). Just after the operation side effects, amnesia and general agreement of the patients were asked. Between two groups the IOP and MAP values were not significantly different before sedation (p>0.05). A significant fall of both values were noted after sedation in both groups. At the end of the operation the values were higher in the second group (p<0.05). The sedation scores were not different between two groups before the application of sedative drugs. After this application significantly deeper sedation was noted in the first group (p<0.05). In the second group the sedation scores were not significantly different before, after the application and at the end of the operation (p>0.05). In the first group, the sedation scores were higher at the end of the operation if compared with values that noted after the application of propofol. The agreement of the patients to this method were better in the first group. As a result, it can be said that; sedation with the combination of droperidol and fentanyl for elective cataract surgery in also possible, but low doses of propofol are better for this purpose.Item The effects of propofol and thiopentone on natural cytotoxic cell activity; [Tiyopenton ve propofol'un naturel killer hucre aktivitesine etkileri](1998) Luleci N.; Erincler T.; Tekin I.; Sengil A.Z.; Tutan A.The effects of thiopentone and propofol on Natural Killer cell activity were studied by the use of candidial colony inhibition method in venous blood samples from healthy volunteers. Following three hours of incubation mean CFU (colony forming unit) was 72.1 in control group while it was 66.3 and 64.1 CFU in samples containing 15 and 150 μL/mL of thiopentone respectively; and 67 and 63.8 in samples containing 5 and 50 μL/mL of propofol respectively. With small doses of propofol and thiopentone colony inhibition was 7% and 8% respectively while high doses leaded higher inhibitions of 11.5% and 11% respectively. It was concluded that a significant increase in anticandidal activity of natural cytotoxic cells is observed with high concentrations of thiopentone and propofol (p<0.01). However, the increase of this activity is not significant in anaesthetic concentrations used in clinical practice.Item Effects of sevoflurane on the cell division and levels of sister cromatid exchange; [Sevofluran hucre bolunmesi ve kardes kromatid degisimi duzeyleri uzerine etkisi](1999) Solak M.; Erincler T.; Luleci E.; Gul R.; Luleci N.; Fistik T.; Tutan A.In this study, the mitotic index (MI) and Sister Cromatid Exchange (SCE) levels were investigated to identify the mutagenic and carcinogenic effects of sevoflurane (sevorane). The data of 20 patients in ASA I-II were studied. All of the patients received an anaesthesia induction with anaesthesia mask and 'tidal volume method. 8 % sevoflurane in 100 % oksigen was used to the induction of anaesthesia and 0.1 mg/kg vecuronium for neuromuscular block and intratracheal intubation. Anaesthesia continued with 2-2.5 sevoflurane, in 60 % N2O and 40 % O2 . Three mL venous blood samples taken before (as controls) 60 minutes, 24 hours and 5 days after the sevoflurane induction, were examined according to the periferic blood culture assay with conventional cytogenetic methods. On the metaphase plaques which obtained in this way, the levels of MI and SCE were examined. As a result, a significant decrease of MI has been found in the test objects at the first 60 minutes of sevoflurane anaesthesia compared to controls (p<0.001). But this depression was smaller after 24 hours (p<0.01) and reversible after 5 days (p>0.05). SCE increased significantly at the first 60 minutes of anaesthesia (p<0.001) was also smaller after 24 hours (p<0.01) and returned to normal levels after 5 days (p>0.05). As conclusion; It has been revealed the effects of sevoflurane on cellular replication and on DNA at the cellular level were repaired in a short period of time. Thus, it has been suggested that sevoflurane had no permanent effect on genetic material of healthy individuals.Item Comparison of propofol and sevoflurane anesthesia by means of blood loss during endoscopic sinus surgery(2004) Sivaci R.; Yilmaz M.D.; Balci C.; Erincler T.; Unlu H.Objective: The purpose of the present investigation is to examine whether induced hypotension with propofol or sevoflurane anesthesia improves the dryness of surgical field in endoscopic sinus surgery (ESS). Methods: The study was performed between 1999 and 2002 in Celal Bayar University and Afyon Kocatepe University Hospitals, Turkey. Thirty-two patients (American Society of Anesthesiologists physical status I and III) with chronic sinusitis undergoing outpatient endoscopic sinus surgery under general anesthesia were studied to determine if anesthetic technique had an impact on estimated blood loss. The patients were allocated randomly into 2 groups. None of the patients were premedicated. Anesthesia was induced with propofol in both groups and maintained with propofol/fentanyl in the first group and sevoflurane/fentanyl in the second group. In both groups, controlled hypotension was used to improve surgical condition. Results: There were no differences between the duration of surgery and intraoperative mean arterial blood pressure when comparing the 2 groups. The average estimated blood loss in the propofol group was 128.1 ± 37.3 ml compared with an average estimated blood loss of 296.9 ± 97.8 ml in the sevoflurane group (p<0.01). Conclusion: General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents. Therefore, making endoscopic surgery technically easier and safer by improving endoscopic visualization of the surgical field.Item Effectiveness of clonidine and fentanyl addition to bupivacaine in postoperative patient controlled epidural analgesia; [Wirksamkeit von clonidin und fentanyl als zusatz bei der postoperativen patientenkontrollierten epiduralanalgesie mit bupivacain](2005) Topcu I.; Luleci N.; Tekin S.; Kefi A.; Erincler T.Background and Objectives: The aim of this prospective randomized double-blinded study was to compare the analgesic and side-effects of bupivacaine in combination with clonidine or fentanyl during patient-controlled-epidural analgesia (PCEA) in the postoperative period after abdominal hysterectomy. Methods: 75 patients from 18 to 65 years of age with ASA status I - II were investigated. After preoperative epidural catheterization, the patients were operated in general anesthesia. After surgery, the patients were randomly allocated to 3 PCEA-groups: Group B 0.125% bupivacaine, Group F 0.125% bupivacaine plus 1 μg × ml-1 fentanyl, Group C 0.125% bupivacaine plus 0.75 μg × ml-1 clonidine (10 ml loading dose, 5 ml repetitive bolus dose, 10 min lockout time, 30 ml limit within 4h). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale (VAS), total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated. Results: Total analgesic consumption was not different between Group F and Group C, but lower than in Group B (p < 0.05). Additional analgesic use was not different between the groups. Group F and Group C had lower VAS-scores in 24 hours than Group B (p < 0.05). Hemodynamic and sedation scores of patients were not different. In Group C, incidence of nausea was lower and satisfaction of patients was higher (p < 0.05). Conclusions: Addition of clonidine or fentanyl to local anesthetics for PCEA can reduce the analgetic demand. Epidural clonidine can reduce postoperative nausea and is connected with higher patients' satisfaction. © Georg Thieme Verlag KG Stuttgart.Item 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.