Browsing by Author "Ok G."
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Item Changes of plasma magnesium concentrations in peroperative magnesium administration for analgesia; [Peroperatif analjezi amaçli magnezyum uygulamasinda plazma magnezyum düzeyi degişiklikleri](2001) Tekin I.; Alincak H.; Ok G.; Erbüyün K.We evaluated the effect of peroperative magnesium replacement on analgesic consumption and changes of plasma magnesium (Mg) concentrations peroperatively. We administered % 0.9 NaCl (Group K, n=20) and MgSO4 (Group M, n=20) bolus and infusion peroperative and untill the end of the postoperative 6th hour in patients undergoing total hysterectomy. Fentanyl 3 μg/kg, propofol 2 mg/kg and vecuronium 0.1 mg/kg had been given in anesthesia induction and continued with % 60 N2O+O2 and 1 % sevoflurane after tracheal intubation into the both groups. Fentanyl 2 μg/kg had been added when heart rate (HR) and mean arterial pressure (MAP) were 15-20 % greater than basal values in all patients. Plasma Mg concentration, MAP and HR were recorded preoperatively, after induction and incision, on postoperative 30. min., 3-6th hours. In addition VAS and sedation scores were recorded postoperatively. Patient controlled analgesia with fentanyl was used for postoperative analgesia. Total fentanyl dose, demand and delivery were recorded. Intraoperative fentanyl consumption was decreased by 40 % in Group M. Postoperative fentanyl consumption was not different between two groups. VAS scores decreased on the 3th and 6th hours in comparison to 30th min postoperatively in Group M. Blood magnesium concentrations were decreased after preoperative period in Group K, and all recordings were higher than preoperative values in Group M. In conclusion, we believed that blood magnesium concentration decreases peroperatively in total hysterectomies, and that the doses we choose were safe despite increased plasma Mg concentration.Item Comparing the effects of two different doses of remifentanil infusion during induction; [Anestezi indüksiyonu sirasinda iki farkli dozda reṁifentanil infüzyonunun karşilaştirilmasi](2002) Tezcan Keleş G.; Yentür E.A.; Sakarya M.; Toprak V.; Ok G.; Taşyüz T.In this study we compared the effects of two different doses of remifentanil infusion on haemodynamic variables and complications during the anesthesia induction. 50 patients, undergoing tympanoplasty operation were enrolled in this study. They were randomly divided into two groups. Before the anesthesia induction, bolus dose of 1 μg kg-1 remifentanil was administered to all patients. Immediately after, an infusion of remifentanil either 0.5 μg kg-1 min-1 min-1 (Grup I: n=25) or μg kg-1 min-1 (Grup II:n=25) was commanced. After three minutes 2 mg kg-1 propofol and 0.1 mg kg-1 vecuronium was administered before tracheal intubation. Anesthesia was maintained with 66 % N2O in O2 and 1.2 % (end tidal) sevoflurane and remifentanil infusion. Hemodynamic values (systolic, diastolic and mean arterial blood pressures and heart rate) and all adverse effects were recorded at 1 and 3 min after the initiation of infusion, before and after intubation, before and surgical incision. For the statistical analysis student's t-test and Mann Whitney -U tests were used. Results were considered significant when p<0.05. With regard to hemodynamic variables systolic, diastolic and mean arterial blood pressures were significantly lower in Group I and Group II three and one minutes after the initiation of remifentanil infusion respectively (p<0.05). Heart rates were significantly lower after the preintubation measurements in group I and after the third minute measurements at group II (p<0.05). There were no hemodynamic response to intubation and skin incision in both groups. At the induction, bradycardia was more prominent in Grup II than Grup I (p<0.05). We concluded that, higher doses of remifentanil did not effect the haemodynamics but lead an increase in adverse effects.Item Anaesthetic management in McKusick-Kaufman syndrome(2003) Tekin I.; Ok G.; Genc A.; Tok D.The cardinal features of McKusick-Kaufman syndrome (MKS) are polydactyly and hydrometrocolpos. Sometimes, this abdominopelvic mass may restrict pulmonary function and decrease the oxygenation of the newborn. We present a case of MKS and review the clinical features and appropriate anaesthetic management. A 45-day-old girl, weighing 4450 g, born at term, presented to our Paediatric Surgery Department with abdominal distention, diarrhoea and vomiting, which started on the 15th day of life. On physical examination, peripheral cyanosis, tachycardia and tachypnoea were found. A prominent mass was palpated in the lower abdomen. There was vaginal atresia and a sixth digit was found on her left foot. There was a large cystic mass extending from the pelvis to the level of L1 displacing the diaphragm, and bilateral hydroureteronephrosis were seen on plain abdominal X-ray, ultrasonography and computerized tomography. In the preanaesthetic assessment, the patient was evaluated for multiple congenital anomalies. Our management of anaesthesia, for a neonate with severe hydrometrocolpos compressing the diaphragm, consisted of gastric decompression and preoxygenation before tracheal intubation, routine and airway pressure monitoring, periodic analyses of blood gases and maintenance of anaesthesia with a low concentration of volatile agent, together with an opioid.Item The effect of diazepam premedication and penthothal induction on upper airway changes by ultrasonography; [Ḋiyazepam premeḋ ikasyonu ve ṫ iyopental ̇ indü kṡiyonunun ÿst hava yolu deǧ̇ iş̇ ikl̇ ikleṙ ine etk̇iṡiṅin ultrasonograḟ ik deǧ erlenḋ iṙ ilmeṡi](2004) Ok G.; Tekin Mirzai I.; Tarhan S.; Lüleci N.We aimed to determine diazepam premedication effect on airway changes during anesthesia induction with thiopental. 40 patients (ASA I-II, aged 20-50 years) who were planned to undergo elective operations were divided into 2 groups. 10 mg diazepam orally one hour before operation, was given to Group I premedication was not given to Group II. We monitored pulse, TA, ECG, SPO2, PETCO2 and kept head in neutral position. We recorded ultrasonographic views of tongue movements by ultrasound probe located below the chin while the patients were ventilating by mask. For anesthesia induction Na pentothal was given iv until lash reflex diminished. Tongue movements were monitored before induction until one minute after lash reflex and consciousness were lost. Difficulty in mask ventilation was recorded. The distance between ultrasound probe and back-front points of tongue arc was measured and differences were recorded. The demografic data and ASA classification of groups were similar (p>0.05). A particular movement of tongue in any direction was not observed in either group (p>0.05). Difficult ventilation with mask was observed in 30% of all patients. In patients with premedication apnea rate was found to be high. We concluded that difficult ventilation with face mask was not result of tongue movement. Difficult ventilation with mask is not related with premedication or anesthetics given for induction alone; diazepam premedication is thought to potantialize central apnea effect of thiopenthal used for induction.Item Volatile induction and maintenance of anesthesia using laryngeal mask airway in pediatric patients(2004) Keleş G.T.; Toprak V.; Ok G.; Lüleci N.[No abstract available]Item Effect of Propofol and Clonidine on Cerebral Blood Flow Velocity and Carbon Dioxide Reactivity in the Middle Cerebral Artery(2004) Mirzai H.; Tekin I.; Tarhan S.; Ok G.; Goktan C.This study was designed to evaluate the effects of propofol alone and propofol-clonidine combination on human middle cerebral artery blood flow velocity (Vmca) and cerebrovascular carbon dioxide (CO2) response by using transcranial Doppler ultrasonography. Mean Vmca in response to changes in arterial partial pressure of CO2 (PaCO2) was determined under the following conditions: awake (group 1), propofol anesthesia (group 2), and combined propofol-clonidine anesthesia (group 3). Normocapnic, hypercapnic, and hypocapnic values of heart rate, mean arterial pressure, partial end-tidal CO2 pressure, PaCO2, and Vmca were obtained. The mean Vmca in groups 2 and 3 was significantly lower than that in group 1 at each level of PaCO2. The calculated Vmca at each level of PaCO 2 was not different between groups 2 and 3. There was a correlation between PaCO2 and Vmca in all groups, but in the anesthetized groups the effect of PaCO2 on Vmca was attenuated. The present data demonstrated that clonidine-propofol does not change CO2 reactivity compared with propofol alone, but both anesthetics attenuate cerebral blood flow compared with awake controls.Item Comparison of intranasal ketamine and midazolam premedication in pediatric patients; [Pediyatrik olgularda i̇ntranazal ketamin ile midazolam premedikasyonunun karşilaştirilmasi](2004) Ok G.; Mirzai I.T.; Leblebici H.; Erbüyün K.In our study, effectiveness and safety of intranasal ketamine and midazolam premedication were compared in pediatric patients. After the approval of ethics' committee, 40 ASA I patients, aged between 2-7 years were divided into two groups. 30 min before operation, in group K (ketamine group), ketamine, 5 mg kg-1 and in group M (midazolam group), midazolam, 0.25 mg kg -1 were administered intranasally. Peripheral O2 saturation (SpO2), systolic arterial blood pressure (SAB), diastolic arterial blood pressure (DAB), heart rate (HR) and respiration rate were recorded at 0, 10, 20, and 30th minutes. Sedation levels of patients were evaluated according to the Ramsey Sedation Scale. Separation from the family were evaluated according to a three level scale; (0: Agitate 1: Calm, 2: Sleeping), iv cannulation condition were evaluated according to a three level scale (1: Agitate 2: Pulling his hand away 3: No reaction). Postoperative Aldrete recovery scores and adverse effects were recorded. Demographic data, SpO2 and respiratory rate were similar in both groups. In both groups, there was a significant decrease in SAB, DAB and HR values according to the baseline values (p<0.05). However, the decrease in SAB in midazolam group was more significant than the ketamine group (p<0.05). The sedation scores after 20th min were found to be higher in midazolam group when compared with ketamine group (p=0.02). Midazolam group had higher scores for iv cannulation which was not statistically significant. The scores for separation from the family were similar in two groups. Aldrete scores were higher in group K than group M which is not statistically significant. In group K, diplopia and nystagmus were detected in 4 patients. We concluded that more profound sedation with midazolam and quicker recovery with ketamine in our results may be determining factors in selection of agents for premedication.Item Hearing loss does not occur in young patients undergoing spinal anesthesia(2004) Ok G.; Tok D.; Erbuyun K.; Aslan A.; Tekin I.Although uncommon, hearing loss after spinal anesthesia has been described. Vestibulocochlear dysfunction after spinal anesthesia in which 22-gauge and 25-gauge Quincke needles were used was investigated to determine if needle size affected hearing. Patients with American Society of Anesthesiologists physical status I and II, aged 20 to 40 years, who were undergoing lower extremity surgery under spinal anesthesia were randomized into 2 groups. After intravenous hydration, 3 mL of 0.5% bupivacaine was administered for spinal anesthesia, which was performed with a 22-gauge Quincke needle in group I (n = 30) patients and a 25-gauge Quincke needle in group II (n = 30) patients. Before surgery and 2 days after surgery, pure-tone audiometry and tympanometry were performed. Preoperative and postoperative hearing data were obtained in the right and left ears for every frequency. Headache, nausea, and vomiting and cranial nerve III, IV, V, VI, VII, and VIII function were assessed on postoperative day 2. Demographic data were not different between the groups. No hypoacousis was noted at any frequency during the entire testing period in either group. Two patients from group I experienced postdural puncture headache on postoperative day 3, and neither had hearing loss. No patient had cranial nerve dysfunction. We were unable to induce hearing loss in young patients undergoing spinal anesthesia by injecting the anesthetic with a 22-gauge or a 25-gauge Quincke needle.Item Carpal tunnel release under intravenous regional anaesthesia with ropivacaine or lidocaine(2005) Tekin I.; Mirzai H.; Ok G.Carpal tunnel syndrome (CTS) surgery is usually performed utilizing regional anaesthesia techniques such as local infiltration, brachial plexus block and intravenous regional anaesthesia (IVRA). The present investigation aimed to compare the clinical effects of IVRA with lidocaine or ropivacaine. Forty patients undergoing carpal tunnel release were divided into two groups (20 each) and 0.1% ropivacaine or 0.25% lidocaine were administred for IVRA. All patients underwent a standard surgical procedure. The patients were asked about their satisfaction regarding analgesia. After tourniquet deflation, patients were evaluated for any signs of side effects. Verbal numerical pain scores of patients were recorded periodically in the postoperative period. Onset of and recovery from sensory anaesthesia and quantification of analgesic consumption were assessed. According to our results, 0.25% lidocaine and 0.1% ropivacaine provided satisfactory anaesthetic quality with a low toxicity profile. The recovery time from sensory block was longer and analgesic consumption was less with ropivacaine than with lidocaine. © 2005 VSP.Item Management of severe household electrical accident victim; [Trattamento di un grave incidente di elettrocuzione avvenuto a domicilio](2006) Toprak V.; Ok G.; Tok D.Objective: To discuss mechanisms and management of severe cardiac arrhythmias caused by household (less than 220 V) electrical injury. Design: We describe a patient with cardiac arrhythmia and neurological dysfunction following low voltage household electrical injury. The patient was in atrial fibrillation with rapid ventricular rate. He was experiencing very short VF and VT attacks. Patient: A 23-year-old previously healthy male. Setting: A 10-bed ICU of Celal Bayar University hospital. Interventions: Invasive monitoring, monitorization of cardiac enzymes, angiography, EEG were performed during the patient's follow-up. Results and Conclusion: Successful pharmacological cardioversion was achieved under amiodarone infusion.Item Anesthesia management in a patient with scleroderma during coronary artery bypass grafting; [Sklerodermali hastada koroner arter cerrahisi sirasinda anestezi yönetimi](2007) Ok G.; Erbüyün K.; Tok D.; Çetin I.; Şirin H.Systemic sclerosis is an autoimmune connective tissue disease, characterized by microvascular occlusive disease with vasospasm, intimal proliferation, cutaneous and parenchymal fibrosis. Anesthesiologists managing patients intraoperatively must be knowledgeable about the pathogenesis, clinical manifestations, system involvement, and anesthetic considerations for the progressive systemic sclerosis surgical patient. The anesthesiologist should understand these complex pathophysiological processes so as to minimize potential risks. We report a 69 year old female patient with systemic sclerosis operated for coronary artery disease.Item Pretreatment with pro- and synbiotics reduces peritonitis-induced acute lung injury in rats(Lippincott Williams and Wilkins, 2007) Tok D.; Ilkgul O.; Bengmark S.; Aydede H.; Erhan Y.; Taneli F.; Ulman C.; Vatansever S.; Kose C.; Ok G.BACKGROUND: To study whether enteral pretreatment with a synbiotic composition of lactic acid bacteria and bioactive fibers can reduce peritonitis-induced lung neutrophil infiltration and tissue injury in rats. MATERIALS AND METHODS: Rats were divided into five groups, and subjected to induction of peritonitis-induced lung injury using a cecal ligation and puncture model (CLP). All animals were pretreated for 3 weeks prior the CLP by daily gavage with either (1) a synbiotic composition (10 CFU of Pediococcus pentosaceus 5-33:3, 10 CFU of Leuconostoc mesenteroides 77:1, 10 CFU of L. paracasei subspecies paracasei, 10 CFU of L. plantarum 2362 plus fermentable fibers), (2) fermentable fibers alone, (3) nonfermentable fibers, (4) a probiotic composition (10 CFU of P. pentosaceus 5-33:3, 10 CFU of L. mesenteroides 77:1, 10 CFU of L. paracasei subsp. paracasei, 10 CFU of L. plantarum 2,362), or (5) a heat-killed probiotic composition. All animals were killed 24 hours after CLP and lung tissue samples were studied for degree of neutrophil infiltration and levels of tumor necrosis factor (TNF)-α, Interleukin (IL)-1β. In addition the lung wet-to-dry tissue weight ratio, the myeloperoxidase activity, and malondialdehyde content were also assessed. RESULTS: No mortality was encountered in any of the groups. Histologic signs of lung injury (number of neutrophils and TNF-α, IL-1β staining) were observed in all groups except the synbiotic and probiotic treated groups. Myeloperoxidase activity and malondialdehyde content were significantly lower in the two lactobacillus- pretreated groups, with no difference between them. Heavy infiltration of lung tissue with neutrophils was observed only in fiber-treated (302.20 ± 7.92) and placebo-treated (266.90 ± 8.92) animals. This was totally abolished in the synbiotic-treated group (34.40 ± 2.49). Lung edema (wet-to-dry lung weight ratio) was significantly reduced in the synbiotic-treated group (4.92 ± 0.13 vs. 5.07 ± 0.08 and 5.39 ± 0.10, respectively). CONCLUSION: Three weeks of preoperative enteral administration of a synbiotic composition reduced peritonitis-induced acute lung injury in rats in a CLP model. © 2007 Lippincott Williams & Wilkins, Inc.Item Efficacy of ropivacaine and ropivacaine+neostigmine combination for elective cesarean section; [Sezaryen operasyonlarinda i̇ntratekal ropivakain ve ropivakain + neostigminin anestezik etkilerinin karşilaştirilmasi](2007) Özaslan S.; Ok G.; Erbüyün K.; Mirzai I.T.The objective of this study is to compare the efficacy of intrathecal ropivacaine and the combination of ropivacaine with neostigmine for elective cesarean sectio. Forty ASA grade I-II parturients were scheduled for elective cesarean delivery under spinal anesthesia. The patients were randomly assigned into two groups. Grup 1 received 15 mg of 0.75 % hyperbaric ropivacaine. Group 2 received 15 mg of % 0.75 hyperbaric ropivacaine combined with 25 μgr neostigmine. Hyperbaric solutions were made with 2 ml of 0.75 % ropivacaine and 0.5 ml of 20 % dextrose. After injection of the spinal medication patients were turned head up 20-30° supine. Baseline mean arterial blood pressure, heart rate, pulse oximetry were recorded and every 5 min during the surgery the same parameters also sensory block level, motor block degree were recorded. Sensory block, motor block and VAS scores were recorded postoperatively at first, second and forth hour. Time until first analgesic requirement and total analgesic consumption in the first 24 hours were recorded. Homodynamic changes, sensory block level, motor block degree, VAS scores, time until first analgesic requirement, postoperative total analgesic consumption were similar among two groups. No statistically noteworthy difference was determined. In conclusion, the time until first analgesic requirement is increased by 25 μgr neostigmine without any adverse effect although there wasn't any significant difference.Item A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint pain(2007) Tekin I.; Mirzai H.; Ok G.; Erbuyun K.; Vatansever D.OBJECTIVES: The goal of this study was to compare the effects of conventional radiofrequency (CRF) and pulsed RF (PRF) denervation to medial branches of dorsal rami in the treatment of facet joint pain. METHODS: The patients greater than 17-year old, with continuous low back pain with or without radiating pain with focal tenderness over the facet joints, pain on hyperextension, absence of neurologic defect, unresponsiveness to conservative treatment, no radicular syndrome, and no indication for low back surgery were included in the study. Local anesthetic was applied in the control group (n=20), whereas 80°C CRF were applied in the CRF (n=20) and 2 Hz PRF were applied in the PRF group (n=20). Pain relief was evaluated by visual analog scale (VAS) and Oswestry Disability Index (ODI) at preprocedure, at procedure, at 6 months and 1 year after the procedure. Reduction in analgesic usage, patients' satisfaction, and complications were assessed. RESULTS: Mean preprocedural VAS and ODI scores were higher than postprocedural scores in all groups. Both VAS and ODI scores of PRF and CRF groups were lower than the score of the control group at the postprocedural evaluation. Although decrease the pain score was maintained in the CRF group at 6 months and 1-year period, this decrease discontinued in the PRF group at the follow-up periods. The number of patients not using analgesics and patient satisfaction were highest in CRF group. DISCUSSION: PRF and CRF are effective and safe alternatives in the treatment of facet joint pain but PRF is not as long lasting as CRF. © 2007 Lippincott Williams & Wilkins, Inc.Item A comparison of the neuroablative effects of conventional and pulsed radiofrequency techniques(Lippincott Williams and Wilkins, 2008) Vatansever D.; Tekin I.; Tuglu I.; Erbuyun K.; Ok G.Objectives: To compare the neuroablative effects of pulsed radiofrequency (PRF) and conventional radiofrequency (CRF) techniques on the sciatic nerve, a peripheral nerve that includes motor, sensory, and autonomous fibers. Methods: The study consisted of 5 groups of 6 adult male Wistar rats. In the control group, no procedure was performed. In the sham group, electrode placement was the same as the other groups, but radiofrequency energy was not given to the rats. In the CRF40 group, 40°C CRF was applied to the rats for 90 seconds. In the CRF80 group, 80°C CRF was applied for 90 seconds. In the PRF group, the rats received 45 V PRF, which did not exceed 42°C for 240 seconds. Two days later, sciatic nerve samples were taken. All specimens were evaluated both with light and electron microscopy. Sciatic nerve morphology was analyzed to compare the effects of CRF and PRF. Kruskal-Wallis and Mann-Whitney U tests were used for comparing the means. Results: Minimal damage was observed in the control group, but damage increased in the sham group and became increasingly more distinct in the PRF, CRF40, and CRF80 groups. Discussion: Nerve tissues can be affected during any type of procedure, even during surgical applications. Our results suggest that PRF is less destructive than CRF for the peripheral nerves. However, this idea should also be investigated at the molecular level, and safety analysis should be performed for routine clinical practice. © 2008 by Lippincott Williams & Wilkins.Item Toxic epidermal necrolysis in the intensive care unit - A case report(2009) Erbüyün K.; Ok G.; Mercan I.; Tok D.[No abstract available]Item Effects of levosimendan and dobutamine on experimental acute lung injury in rats(2009) Erbüyün K.; Vatansever S.; Tok D.; Ok G.; Türköz E.; Aydede H.; Erhan Y.; Tekin I.The effects of levosimendan on acute lung injury induced by peritonitis and abdominal hypertension in the early stages of sepsis in rats were investigated. Twenty-four adult male Wistar rats were randomized into: (1) sham, (2) subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture, then treated by dobutamine, (3) subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture, then treated by levosimendan, and (4) controls subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture with no treatment. In the control and levosimendan groups, cecal ligation and puncture resulted in moderate IL-1β immunolabelling in lung tissue; marked IL-1β immunolabelling was demonstrated in the dobutamine group. TNF-α immunolabelling was negative in both the sham and levosimendan groups, but moderate and weak immunoreactivities were observed in the dobutamine and control groups, respectively. There were almost no TUNEL positive cells in the sham, but they were prominent in the control. TUNEL positive cells were significantly less in the levosimendan treated lungs when compared to control and dobutamine groups. Immunoreactivity of eNOS was stronger in the dobutamine group when compared with the levosimendan group. In addition, iNOS immunoreactivity was strongly detected in the control group; this immunoreactivity was less in the levosimendan group than the dobutamine group. In this experimental sepsis model, treatment with levosimendan had a marked effect on attenuating or decreasing apoptosis and inflammation in the lung. © 2008 Elsevier GmbH. All rights reserved.Item New delirium rating scale for ICU; [yoǧun bakım olgularinda yeni deliryum deǧerlendirme skalası](Turkish Neuropsychiatric Society, 2010) Ok G.; Aydemir O.; Tok D.; Erbüyün K.; Turan E.Objective: The New Delirium Rating Scale (NDRS) makes use of verbal assessments to evaluate the cardinal features of delirium and is an observer-rated, 10-item symptom rating scale based on both DSM-IV and the findings of the previous clinical research. In this study, we tested the validity of the NDRS for measuring the severity of delirium in intensive care units. Methods: Thirty consecutive non-intubated patients admitted to the ICU for more than 24 hours were included in the study. Two intensivists were trained to rate delirium according to NDRS and they daily carried out structured interviews to evaluate the patients. All patients were interviewed by a psychiatrist for rating according to NDRS, and the data collected by the psychiatrist and the intensivists were compared. Results: The cut-off score for NDRS was 11.3 patients (10%), who were rated as delirious. The inter-rater reliability of the intensivists and the psychiatrist was found to be 0.84 and 0.90, respectively (p<0.0001). Conclusion: Intensivists easily used NDRS, a detailed delirium assessing scale, and rated delirium successfully. © Archives of Neuropsychiatry, published by Galenos Publishing.Item Levosimendan up-regulates transforming growth factor-beta and smad signaling in the aorta in the early stage of sepsis; [Levosimendan erken dönem sepsiste aortada "transforming growth factor beta" ve Smad işaretlenmesini up-regüle eder](Turkish Association of Trauma and Emergency Surgery, 2010) Erbüyün K.; Tok D.; Vatansever S.; Ok G.; Türköz E.; Aydede H.; Erhan Y.; Tekin I.BACKGROUND This prospective, controlled experimental study was planned to investigate the effects of levosimendan on transforming growth factor (TGF)-β3 and Smad1, Smad2 and Smad3 expression in the early stages of sepsis. METHODS Twenty-four rats were randomized into four groups: 1) sham-operated controls, 2) dobutamine group - subjected to abdominal hypertension and peritonitis-induced sepsis using cecal ligation and puncture (CLP), then treated with 10 μg.kg-1min-1 intravenous (IV) dobutamine infusion, 3) levosimendan group - as in 2, then treated with levosimendan IV bolus 200 μg.kg-1 followed by 200 μg.kg.-1 min-1 IV infusion, and 4) a control group as in 2, with no treatment. All rats were killed 8 hours after CLP. Aorta tissue samples were analyzed by immunohistochemical staining. RESULTS CLP caused mild interleukin (IL)-1 immunostaining in both control and dobutamine groups. Immunoreactivity of tumor necrosis factor (TNF)-α was mild in both sham and control groups. TGF-β3 immunostaining was mildly increased in groups sham, control and dobutamine, whereas it was found moderate in group levosimendan. Smad1, Smad2 and Smad3 were found moderately increased only in group levosimendan. CONCLUSION Beneficial effects of levosimendan on hemodynamics and global oxygen transport were reported in experimental and clinical trials. Besides its potency on C++ ion sensitivity, it should influence inflammatory cytokine production by diminishing TGF-β3 and Smad1, Smad2 and Smad3 expression.Item Evaluating sleep characteristics in intensive care unit and non-intensive care unit physicians(Australian Society of Anaesthetists, 2011) Ok G.; Yilmaz H.; Tok D.; Erbüyün K.; Çoban S.; Dinç G.Healthcare workers' cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P=0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep parameters were statistically different between the groups when evaluated before and after shift-work (P >0.05). However in both ICU and non-ICU physicians, sleep latency was observed to be decreased within the three consecutive-day period after shift-work with respect to basal values (P <0.001). Total sleep time, total activity score and sleep efficiency scores prior to shift-work were significantly different from shift-work and the three consecutive-days after shift-work, in both groups. Working in the ICU does not have an impact on objective sleep characteristics of physicians in this study. Large cohort studies are required to determine long-term health concerns of shift-working physicians.