Browsing by Author "Sakarya M."
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Item Anaesthetic management of severe bradycardia during general anaesthesia using temporary cardiac pacing(Oxford University Press, 2002) Toprak V.; Yentur A.; Sakarya M.There are few reports of management of severe bradycardia with temporary cardiac pacing. We describe a 65-yr-old female patient who developed bradycardia and hypotension on two occasions during general anaesthesia for laryngoscopy. The first episode was treated with atropine, ephedrine, and colloid infusion and the second with a temporary pacemaker and ephedrine.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 Upper extremity compartment syndromes following vipera snake bite(2002) Keleş G.T.; Yentür A.; Sakarya M.The aim of this report is present two cases of compartment syndrome following snake envenomations. Both of patients, which are 63-year-old woman and 2-year-old boy, were bitten on their hands by snake. After 48 hours, in the both patients hands oedema and pain progressed. Later echymosis, cyanosis and paresthesia developed and the pulses could not be detected anymore. Both of the cases were diagnosed as compartment syndrome and after fasciotomy they recoveried completely. We postulate that compartment syndrome may occur following snake bites as a delayed local complication, even if signs of systemic poisoning are missing.Item The Effect of Hyperventilation on the Increase of Cerebral Blood Flow Velocity Secondary to Deflation of the Tourniquet in Lower Extremity Surgery; [Alt Ekstremite Cerrahisinde Turnike Açilmasina Sekonder Beyin Kan Akim Hizi Artişina Hiperventilasyonun Etkisi](2003) Sakarya M.; Topçu I.; Özkol M.; Yentür A.; Yercan H.; Okçu G.We aimed to investigate the effects of hyperventilation on cerebral blood flow (CBF) in order to maintain normocapnia following the deflation of the tourniquet in patients undergoing elective lower extremity operation during intravenous general anesthesia (TIVA). In all cases(n=15), anaesthesia was induced by 2 mg kg-1 propofol, 1 μg kg-1 remifentanyl and 1 mg kg-1 vecuronium, and was maintained with the mixture of 50 % air-O2, 6-8 mg kg-1 dk-1 propofol and 0.5 μg kg-1 dk-1 remifentanyl infusions. Patients were randomized into two groups. Group I (n=7) was ventilated by f=10/min and V T=8 mL kg-1. Patients in group II (n=8) were ventilated similarly as group I until the deflation of tourniquet, and following deflation by increasing respiratory frequency adjusted to maintain end-tidal CO 2 (PETCO2) between 30-35 mmHg. Middle cerebral artery (MCA) flow velocity was measured by transcranial Doppler ultrasonography as mean (m-MCA) and peak (p-MCA) values. Data were recorded 5 minutes before tourniquet deflation (control), and every minute in the first 10 minutes following deflation While there has been no difference for p-MCA, m-MCA and PaCO2 in group II, significant increases (p<0.05) in mean MCA flow velocity were obtained in 2nd, 3rd and 4th minutes in group I. Maximum increase was obtained in 3rd minute and determined as 52±7 cm/sec. The increases of PaCO2 were obtained in 2 to 6 minutes (p<0.05) and maximum level was 41±1 mmHg (25 %±3 %) in 3rd minute. We concluded that, the increase of MCA flow velocity and CBF related to the increase of PaCO2 after deflation of the pneumatic tourniquet may be prevented by maintaining normocapnia provided by increasing minute ventilation.Item Snake bite and compartment syndrome (two case report); [Yilan zehirlenmesi ve kompartman sendromu (iki olgu nedeniyle)](2003) Tezcan Keleş G.; Toprak V.; Yentür A.; Sakarya M.The aim of this report is to present two cases of compartment syndrome following snake bite. Both patients (63-year-old woman and 2-year-old boy) were bitten by snakes from their hands. 48 hours later oedema and pain in both patients hands progressed. Echymosis, cyanosis and paresthesia developed and the pulses could not be palpated. Both of the cases were diagnosed as compartment syndrome and fasciotomy resulted in recovered completely. We postulate that compartment syndrome may occur following snake bites as a delayed localized complication, even if signs of systemic poisoning do not exist.Item Subanalgesic Dose of Ketamine Added to Tramadol Does Not Reduce Analgesic Demand; [Tramadole, Subanaljezik Dozda Ketamin İlavesi Analjezik Gereksinimini Azaltmiyor](2004) Yentür E.A.; Topçu I.; Keleş G.T.; Taşyüz T.; Sakarya M.Tramadol is an analgesic with agonistic properties on opioid receptors. In this study we investigated the effect of systemic coadministration of subanalgesic dose of ketamine with tramadol on postoperative tramadol consumption. By this way we intended to find a clue whether tramadol also have opioid induced algesic effect like morphine via NMDA receptors. Thirty patients undergoing abdominal surgery with general anesthesia were enrolled in this prospective, placebo controlled, double blind study. Anesthesia was induced with propofol 2-2.5 mg kg-1 and was maintained with sevoflurane in N2O/O2 mixture. Muscle relaxation was provided by vecuronium. Analgesia was maintained by iv remifentanyl infusion. Infusion of remifentanyl was stopped 15 min before the end of operation, and 10 min later patients were randomly administered either 75 mg kg-1 ketamine (5 mL) and 1 mg kg-1 tramadol (ketamin group) or normal saline (5 ml) and 1 mg kg-1 tramadol bolus (placebo group). Intravenous PCA with tramadol was started on the arrival at postoperative recovery room, and continued for 24 hours in all patients. Pain and sedation scores were evaluated in the recovery room every 15 min until the time of discharge to the ward. Aldrete Post Anesthesia Recovery Scores (≥9) were used as discharge criteria. Total tramadol consumptions at the 6th and 24th hours were recorded. There was no significant difference between the groups with respect to Visual Analog Scale (6.1±1.1 vs 6.6±1.1) and total tramadol consumption (51.5±26.4 vs 53.7±18.3 mg) at the end of recovery period (p>0.05). Also the total tramadol consumptions at 6th and 24th hours (188.9±82.9 vs 215.3±104.7 and 365.0±118.6 vs 403.8±243.8 respectively) were not different between groups (p>0.05). Subanalgesic dose of ketamine did not augment tramadol induced analgesia so these findings may suggest that tramadol does not have NMDA receptor activating property like morphine.Item Relationship between nutrition and ASA-classification in the elderly; [Der zusammenhang von ernährungszustand und ASA-klassifikation bei älteren patienten](2004) Sakarya M.; Karadaǧ F.; Lüleci N.; Keleş G.T.; Topçu I.; Erinçler T.Objective: Old age and bad nourishment are risk factors for the postoperative period. In this study, the "mini nutritional assessment" (MNA) of elderly patients was evaluated before the operation and compared with their ASA-classification. Methods: 215 outpatients (age > 60 years) were included. MNA-score was fixed as follows: MNA 24 - 30 = normal (MNA I); MNA 17 - 23.5 = risk of malnutrition (MNA II; MNA < 17 = undernourished (MNA III). In addition, the ASA-score of all patients was registered. χ2-, Mann-Whitney-U- and correlation analysis were used for statistical analysis. A cut off-value of 24 was fixed for MNA and correlated with the ASA-score. Results: 34,9% of all patients were allocated to MNA II or III, but only 19.9% to ASA III or IV. The sensivity of the ASA-classification for evaluation of the nutritional status was 0.33, selectivity was 0.87, positive predictive value was 0.58 and negative predictive value was 0.70. Conclusion: ASA evaluation is not suitable for assessment of the nutritional status. With regard to typical postoperative complications, the nutritional status of patients should be assessed separately.Item Importance of post anesthesia care unit: Pneumothorax developed after panendoscopy and supraclavicular mass excision (case report); [Anestizi sonrasi bakim ünitesinin önemi: Panendoskopi ve supraklaviküler kitle eksizyonu sonrasi gelişen pnömotoraks (olgu sunumu)](2004) Tezcan Keleş G.; Toprak V.; Yentür A.; Sakarya M.Acute respiratory distress in early postoperative period is a severe clinical life threating state. Pneumothorax is one of the reasons. The possibility of a postoperative pneumothorax should be considered following central line placement, intercostal blocks, neck dissections, tracheostomy, or intra-abdominal procedures. A chest radiograph should be taken in the recovery room if there is a possibility of pneumothorax following any of the above procedures. In this case report, we present a postoperative pneumothorax was diagnosed and treated in 60 year old male patient, in the postoperative recovery room, after panendoscopy and diagnostic supraclavicular mass excission. Although there is no clinical sign in the perioperative period, we emphasize the importance of postoperative close monitorization and follow-up.Item Assessment of neuromuscular and haemodynamic effects of cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia in elderly patients(2004) Keleş G.T.; Yentür A.; Çavuş Z.; Sakarya M.Background and objective: Neuromuscular block times, quality of muscle relaxation for tracheal tube insertion, and the haemodynamic effects after cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia were compared in elderly patients. Methods: The study was performed in 40 patients over 65 yr of age. Anaesthesia was induced with thiopental, and maintained with sevoflurane in N2O/O2 and remifentanil. Cisatracurium 0.15 mg kg-1 or vecuronium 0.1 mg kg-1 were administered after induction. Intubation was attempted when neuromuscular block was 95%. Onset time, clinical duration of action, recovery index, spontaneous recovery time and tracheal intubation conditions were assessed. Haemodynamic parameters were also monitored. Results: The average ages of the patients were 72.5 ± 5.1 and 73.6 ± 6.3 in the cisatracurium and vecuronium groups, respectively. Onset time was significantly shorter after vecuronium, 158 ± 34s vs. 200 ± 50s, respectively. Recovery index was significantly shorter after cisatracurium, 19.5 ± 7.5s vs. 33.7 ± 18.6s (P < 0.05). Clinical duration and spontaneous recovery time were similar in both groups as well as haemodynamic variables. Conclusions: In elderly patients, vecuronium has a faster onset time while cisatracurium has a shorter recovery index under sevoflurane-remifentanil anaesthesia.Item 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.Item Effects of sevofluran on cell division and levels of sister chromatid exchange; [Die wirkung von sevofluran auf zellteilung, mitose-index (MI) und austausch der schwesterchromatide (sister chromatide exchange SCE)](2005) Lüleci N.; Sakarya M.; Topçu I.; Lüleci E.; Erinçler T.; Solak M.Objective: Purpose of the study was to investigate the mitotic index (MI) and sister chromatid exchange (SCE) levels to identify the mutagenic and carcinogenic effects of sevoflurane (sevoflurane). Methods: 42 non-smoking male and female turkish patients of ASA-risk I and II were included. The patients received an anaesthesia induction with 8% sevoflurane in 100% oxygen ("tidal volume methode") and 0,1 mg/kg BW vecuronium for neuromuscular block and endotracheal intubation. Anaesthesia was maintained with 2.0-2.5 sevoflurane in 60% N2O and 40% O2. Four 5 ml venous blood samples werde taken: before induction (control), 60 minutes, 24 hours and 5 days after sevoflurane anesthesia. Samples were prepared according to the periferic blood culture assay, modified by Morhead and co-workers, and levels of MI and SCE were examined. Results: 60 minutes after sevoflurane-anaesthesia a significant decrease of MI was found compared to controls (p < 0.01). This depression was lower after 24 hours (p < 0.05) and reversible after 5 days. SCE increased significantly during 60 minutes of anaesthesia (p < 0.001), was also lower after 24 hours (5.6 ± 2.4 vs. 4.4 ± 1.7) and returned to normal levels after 5 days (p > 0.05). Conclusion: The application of sevoflurane for anaesthesia may influence the cell division in humans and may have a mutagenic effect on DNA at the cell level, which is reversible.Item 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.Item 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.Item Severe trombocytopenia accompaning citrobacter freundii bacteriemia following secarean section (case report); [Sezaryen operasyonu sonrasi citrobacter freundii bakteriyemisine eşlik eden ciddi trombositopeni (olgu sunumu)](2005) Tezcan Keleş G.; Kaygisiz Z.; Tünger Ö.; Sakarya M.Peripartum bacteremia is associated with preterm pregnancies and cesarean sections. Citrobacter are gram-negative bacilli that can cause opportunistic infections. Overall mortality of Citrobacter bacteremia is seen in 48%. Early diagnosis and prompt treatment can lessen complications. In the present case, (with Citrobacter freundii bacteriemia and immun thrombocytopenia) 29 years old, 34 weeks pregnant woman who had got platelet counts decreased 15.000 mL-1 at postoperative first day following cesarean section, and related clinical conditions and probable etiologic factors are presented.Item 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.Item Comparison of effects of dexmedetomidine and magnesium in traumatic brain injury; [Travmatik beyin hasarinda serebral korumada deksmedetomidin ve magnezyumun etkilerinin karşilaştirilmasi](2006) Çavuş Z.; Topçu I.; Vatansever S.; Var A.; Sakarya M.Aim: Prevention of secondary serebral injury plays a major role in intensive care of head injury patients. In this study, the effects of dexmedetomidine and magnesium to prevent brain injury in head trauma are compared. Materials and Methods: Diffuse head injury was induced in 30 adult Wistar albino male rats by Marmarou method after anesthetized by intraperitoneal injection of 30 mg kg-1 sodium thiopental. Rats were divided randomly into 3 groups, each consisting of 10 rats: 2 mL saline to Group 1, 2 mL 100 μg kg-1 dexmedetomidine to Group II and 2 mL 750 μmol kg-1 magnesium sulphate to Group III were administered by intraperitoneal route. Rats were sacrificed by cervical dislocation 120 minutes after the drug administration and brain tissues were obtained without damaging the brains. Brain tissue samples were divided into two by interhemispheric incision for biochemical and histological analysis. Brain tissues were fixed in 10% formalin solution and embedded in paraffin and examined by hematoxylin-eosin staining for morphological alterations. Sections were stained via TUNEL method in order to detect apoptosis. The tissue concentration of malonyldialdehyde (MDA), Superoxide dismutase (SOD) and glutathione peroxidasc (GSH-Px) in brain tissue was also measured. Results: Hematoxylin-eosin-stained brain sections arc compared; dexmedetomidine is more effective than magnesium in reducing brain cell injury caused by head trauma. Evaluation of apoptosis by the TUNEL method revealed that magnesium is more effective than dexmedetomidine in preventing cell death. Malonyldialdehyde (MDA) levels of Group I was found significantly lower than Group II and III (p<0.05). Also the decrease in the level of superoxide dismutase (SOD) in Group I was found significantly higher than Group II and III. There was no difference in glutathione peroxidasc (GSH-Px) levels between the groups. Conclusion: Dexmedetomidine reduces secondary cerebral injury significantly: however, magnesium prevents apoptosis more effective than dexmedetomidine in experimental models of diffuse traumatic brain injury. The effects of magnesium and dexmedetomidine in brain cell protection may occur through different mechanisms but not by enzymes because the biochemical results arc in contradiction with the histopathological analysis.Item The effects of esmolol on anesthetic and analgesic requirement; [Esmololün anestezik ve analjezik gereksinimi üzerine etkisi](2007) Topçu I.; Öztürk T.; Taşyüz T.; Işik R.; Çetin I.; Sakarya M.Aim: There are many adjuvant agents which decrease the need of anesthetic and analgesic drugs during general anesthesia management. The comparison of the effects of esmolol, a β1 receptor antagonist with a ultra-short-acting, is aimed upon the consumption of analgesic, anesthetic and neuromuscular blocker drugs in this randomized, double-blinded study. Materials and Methods: 18-70 year old, ASA I-II, 60 patients scheduled for elective abdominal operations under general anesthesia were equally divided into 2 groups. In Group E; 1 mg kg-1 esmolol infusion was started slowly prior to induction and 250 μg kg-1 min-1 esmolol infusion lasted during the operation, in Group C (control group) isotonic solution was administered in the same volume. Propofol (due to BIS values) and remifentanil (due to heart beat rate and blood pressure) were administered by TIVA in anesthesia maintenance to the patients. Rocuronium was used as a neuromuscular blocker drug. All hemodynamics values of the cases, the amounts of the anesthetic consumption, analgesic and neuromuscular blocker drugs before and after induction were recorded. Results: There was no difference for age, gender, type and period of operation and induction doses between the groups (p>0.05). The need of analgesic and anesthetic drug was decreased but the consumption of neuromuseular blocker drug not affected in Group E than Group K (p<0.05). Mean arterial blood pressure and heart beat rate variables were more stabile in the perioperative period in Group E. The hemodynamic response to intubation and extubation were reduced by esmolol infusion. Conclusion: The results suggest that the perioperative esmolol administration may reduce intraoperative requirement of the anesthetics and the analgesic to prevent acute autonomic responses during anesthesia and surgery.Item Post-tracheal extubation pulmonary edema in an infant - Case report; [Bebekte ekstübasyon sonrasi gelişen akciǧer ödemi - Olgu sunumu](2007) Topçu I.; Keleş G.T.; Alp Yentür E.; Zeynep Ekici N.; Sakarya M.Upper airway obstruction related to laryngospasm after extubation may lead to negative pressure pulmonary edema. The proposed mechanism is the generation of high negative pressures during respiratory effort associated with glottis closure and laryngospasm leading to pulmonary edema and alveolar hemorrhage. A male premature, twin baby, 2.5 month old, weighing 6 kg was scheduled to perform cystoscopy under general anesthesia for the purpose of diagnosis. After uneventful induction and operation, the infant was extubated. Approximately 5 minutes after extubation, the infant performed significant laryngospasm associated with respiratory distress, tachypnea, cyanosis and significant decrease in peripheral oxygen saturation. Consequently, the patient was reintubated and transferred to the Anesthesiology Intensive Care Unit for mechanical ventilation and further treatment. After 4 hour of mechanical ventilation support, the patient was extubated at the 6th hour. Postoperative 48th hour, he was discharged to the pediatric surgery unite. Negative pressure pulmonary edema is a serious, life-threatening, clinical condition requiring reintubation and mechanical ventilation support associated with prolonged hospital stay even in pediatric cases. Early recognition of patients at risk and preventing laryngospasm are important.Item The effect of Misoprostol, a prostaglandin E1 analog, on apoptosis in ischemia-reperfusion-induced intestinal injury(Elsevier GmbH, 2007) Topcu I.; Vatansever S.; Var A.; Cavus Z.; Cilaker S.; Sakarya M.The aim of this study was to investigate whether Misoprostol, a synthetic prostaglandin (PG) E1 analog, has any effect on the prevention of apoptosis in ischemia-reperfusion (I/R)-induced intestinal injury. Thirty adult male Wistar albino rats were divided into three groups: group I=sham operated+saline; group II=I/R+saline; and group III=I/R+Misoprostol. Misoprostol (50 μg/kg/d) was administered as an intragastric meal for 3 days. The terminal ileum was collected for histological and biochemical investigations. Apoptotic cells were detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labelled (TUNEL) reaction. Immunohistochemical analysis was performed to determine the distribution of inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS). Samples were also analyzed for malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). The number of TUNEL-positive cells was higher in group II when compared to the other two groups (p<0.05). In group III this value was higher when compared to group I, but lower than group II (p<0.05). iNOS immunoreactivity was not detected in ileum sections of group I animals, but moderate immunoreactivity was seen in group II and mild immunoreactivity in group III. The immunoreactivity of eNOS was moderate in ileum sections of all three groups. In ileum tissue, MDA was found to be higher in group II compared to group I (p<0.05), but there was no difference in group III. SOD was not different between groups I and III, but was significantly higher in group II (p<0.05). In our experimental model of I/R-induced intestinal injury, apoptosis is induced in enterocytes, whereas Misoprostol decreases enterocyte apoptosis in this experimental model. Our results indicate that Misoprostol may play a key role in the pathophysiologic events leading to failure of the intrinsic gut barrier defense mechanisms of intestinal epithelium. © 2007 Elsevier GmbH. All rights reserved.Item Effects of esmolol on hemodynamic responses to laryngoscopy and tracheal intubation in diabetic versus non-diabetic patients(2007) Taşyüz T.; Topçu I.; Özaslan S.; Sakarya M.Aim: We aimed to investigate the efficiency of esmolol, a short-acting β-blocker, in preventing the hemodynamic response to laryngoscopy and endotracheal intubation in diabetic patients. Materials and Methods: Eighty diabetic or non-diabetic patients with ASA physical status I-II scheduled for noncardiac surgery were included in this study. They were divided randomly into 4 groups (Non-diabetic control: NDC, Non-diabetic esmolol: NDE, Diabetic control: DC, Diabetic esmolol: DE). Blood glucose analyses were measured in the preoperative period and at the 10th min of the study. Prior to anesthetic induction, 1 mg/kg esmolol to Groups NDE and DE and saline to Groups NDC and DC were administered in 1 min by slow infusion. After 2 mins, systolic and diastolic arterial blood pressures (SBP, DBP), heart rate (HR), bispectral index (BIS) and peripheral oxygen saturation (SpO2) were recorded in all groups. Laryngoscopy and endotracheal intubation were performed after induction. SBP, DBP, HR, SpO2 and BIS values were recorded every minute during 10 mins after intubation. Results: In Groups NDE and DE, SBP, DBP and HR values were significantly lower after drug administration than the values obtained before drug administration (p<0.05). In Groups NDC, NDE and DC, SBP, DBP and HR values were significantly higher in the first minute of the intubation compared to before drug administration (p<0.05), but were significantly low in subsequent measurements (p<0.05). Blood glucose analyses were found significantly higher in Group NDE than Group NDC (p<0.05). Conclusions: We propose that esmolol might be used effectively to control hemodynamic response to tracheal intubation in diabetic patients. We also determined that esmolol causes no difference in blood glucose levels. © TÜBİTAK.