Browsing by Author "Tekin, I"
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Item Neurotoxicity of chronic epidural somatostatin administration in rabbitsTekin, I; Mirzai, H; Yentur, EA; Ates, U; Baka, M; Yurtseven, MThe central administration of somatostatin (SMS) in humans became a subject of controversy on the issue of potential neurotoxicity on the spinal cord. The study was aimed at the assessment of the neurodegenerative effects of chronic epidural SMS administration in rabbits. Rabbits were randomly assigned to two groups: the SMS and the control group. The SMS group received 100 mug SMS and the control group received isotonic saline by epidural catheter for 15 consecutive days. Then, laminectomy was performed and the spinal cord was removed. Light and electron microscopic examinations were performed. In the control group, a mild dural inflammatory response and in the SMS group, loss of Nissl bodies at the pericarion, chromatolysis and shrinking at nucleus membranes were observed in all animals at different degrees in light microscopy. In electron microscopy, mitochondrial swellings, irregularities in both nucleus and cell membrane, splitting at myelin lamellae, degeneration at myelin sheath and shrinking of axolemma were found in the SMS group. Our results showed the neurotoxic effects of chronic administration of SMS in rabbits both in light and electron microscopy even in a quite low doses. However, there were no significant clinical findings for the neurological effects during long term follow up.Item The Assessment of Parental Anxiety in Pediatric Surgery CasesAsik, K; Erbuyun, K; Taskin, EO; Yilmaz, O; Demet, A; Tekin, I; Ok, G; Asik, EAItem The role of ultrasound guidance in pediatric caudal blockErbüyün, K; Açikgöz, B; Ok, G; Yilmaz, Ö; Temeltas, G; Tekin, I; Tok, DObjectives: To compare the time interval of the procedure, possible complications, post-operative pain levels, additional analgesics, and nurse satisfaction in ultrasonography-guided and standard caudal block applications. Methods: This retrospective study was conducted in Celal Bayar University Hospital, Manisa, Turkey, between January and December 2014, included 78 pediatric patients. Caudal block was applied to 2 different groups; one with ultrasound guide, and the other using the standard method. Results: The time interval of the procedure was significantly shorter in the standard application group compared with ultrasound-guided group (p=0.020). Wong-Baker FACES Pain Rating Scale values obtained at the 90th minute was statistically lower in the standard application group compared with ultrasound-guided group (p=0.035). No statistically significant difference was found on the other parameters between the 2 groups. The shorter time interval of the procedure at standard application group should not be considered as a distinctive mark by the pediatric anesthesiologists, because this time difference was as short as seconds. Conclusion: Ultrasound guidance for caudal block applications would neither increase nor decrease the success of the treatment. However, ultrasound guidance should be needed in cases where the detection of sacral anatomy is difficult, especially by palpations.Item Hearing loss does not occur in young patients undergoing spinal anesthesiaOk, G; Tok, D; Erbuyun, K; Aslan, A; Tekin, IBackground and Objectives: 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. Methods: 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. Results: 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. Conclusions: 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 Urethral meatal dilatation using topical EMLA cream for anaesthesiaGenç, A; Tekin, I; Arslan, OA; Taneli, C; Mir, EItem A comparison of the neuroablative effects of conventional and pulsed radiofrequency techniquesVatansever, D; Tekin, I; Tuglu, I; Erbuyun, K; Ok, GObjectives: 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 degrees C CRF was applied to the rats for 90 seconds. In the CRF80 group, 80 degrees C CRF was applied for 90 seconds. In the PRF group, the rats received 45 V PRF, which did not exceed 42 degrees 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.Item Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery - A randomized controlled trialMirzai, H; Tekin, I; Alincak, HStudy Design. A prospective and controlled study of perioperative use of combined local anesthetic and corticosteroid in lumbar disc surgery. Summary of Background Data. The anti-inflammatory mechanism of corticosteroids is considered to be caused by the inhibition of phospholipase A(2), which plays an important role in the pain mechanism of lumbar disc problems. Although some authors have demonstrated that the use of intramuscular bupivacaine during lumbar discectomy resulted in a marked reduction of postoperative back pain, others have reported that the key intervention was probably the administration of epidural corticosteroid. The coadministration of these two drugs in lumbar disc surgery for the relief of postoperative back pain has yet not been studied adequately. Objectives. Assessment of the combined use of perioperative corticosteroids and bupivacaine for the relief of postoperative pain after lumbar disc surgery. Methods. Forty-four selected patients had acute-onset single-level unilateral herniated nucleus pulposus that were refractory to conservative management. All patients underwent lumbar disc surgery under standard general anesthesia. Before surgical incision, the skin and subcutaneous tissues were infiltrated with 10 mL of 1% lidocaine with 1:200,000 adrenaline to produce local vasoconstriction. During wound closure, 20 mL 0.9% saline in Group 1 (n = 22) and 20 mL 0.25% bupivacaine in Group 2 (n = 22) were injected into the paravertebral muscles band subcutaneus tissues. In addition, a piece of autologous fat taken from the wound was first soaked in 40 mg of methylprednisolone for 10 minutes, then placed over the exposed nerve root, and the remaining steroid was flushed into the wound in Group 2. The wound was closed after drug administration in both groups. In the postoperative period, all patients received 100 mg of meperidine intramuscularly when needed and were allowed to receive a second dose at least 4 hours later than the first dose for postoperative analgesia. Postoperative back pain intensity, heart rate, and mean arterial pressure were assessed 1, 3, 6, and 12 hours after the conclusion of surgery. Results. Visual analog scale pain scores for the postoperative recordings were lower in Group 2 than in Group 1, but these findings were not statistically significant. Patients in Group 1 received 77.3 +/- 48.8 mg meperidine, and those in Group 2 received 31.8 +/- 45.5 mg meperidine, for pain medication in the first 12 hours (P < 0.05). Heart rate and mean arterial pressure were not significantly different between the two groups in all recording periods. Conclusion. It is concluded that the perioperative use of bupivacaine and corticosteroids during lumbar discectomy maintains effective postoperative analgesia and decreases opioid usage without complications.Item Anaesthetic management in McKusick-Kaufman syndromeTekin, I; Ok, G; Genc, A; Tok, DThe 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 Effect of Transcutaneous Electrical Nerve Stimulation on Postoperative Pain and Patient SatisfactionYilmaz, E; Karakaya, E; Baydur, H; Tekin, IBackground and Aims: This study was conducted to investigate the effect of transcutaneous electrical nerve stimulation on postoperative pain, changes in patients' vital signs, and patient satisfaction after inguinal herniorrhaphy. Design: This study used a randomized controlled design. Setting: A state hospital in the west of Turkey. Participants/Subjects: The study was conducted on 52 patients who had inguinal herniorrhaphy between January and July 2015. Methods: Patients were randomly divided into two groups (intervention and control). Intervention group patients received transcutaneous electrical nerve stimulation postoperatively five times for 30 minutes each. Electrodes in control group patients were placed, but the device was not started. At each transcutaneous electrical nerve stimulation session, the patients' vital signs and pain severity were recorded. A satisfaction scale was administered before discharge to assess patient satisfaction with nursing care. Results: Pain scores of patients in the intervention group were lower than those in the control group (p < .05). No differences were found in pre- and post-transcutaneous electrical nerve stimulation in the vital signs. Satisfaction scores were higher in the intervention group than control group (p < .05). Conclusions: After inguinal herniorrhaphy, transcutaneous electrical nerve stimulation reduced post-operative pain without a negative impact on vital signs and increased patient satisfaction with nursing care. (C) 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.Item The results of nucleoplasty in patients with lumbar herniated disc: a prospective clinical study of 52 consecutive patientsMirzai, H; Tekin, I; Yaman, O; Bursali, ABACKGROUND CONTEXT: Nucleoplasty is a minimally invasive, percutaneous procedure that uses radiofrequency energy to ablate nuclear material and create small channels within the disc. PURPOSE: To evaluate the efficacy of nucleoplasty technique in patients with leg pain caused by radicular encroachment. STUDY DESIGN/SETTING: A prospective clinical study of subjects with lumbar disc herniation, and radicular pain resistant to previous medical treatment and physiotherapy for a period of at least 3 months. PATIENT SAMPLE: Fifty-two consecutive patients with leg pain and magnetic resonance imaging evidence of small and medium-sized herniated discs correlating with the patient's symptoms (contained disc herniation <6 mm, with a disc height >= 50% in comparison to normal adjacent discs) were included. OUTCOME MEASURES: Visual analogue scale (VAS) was administered and Oswestry disability questionnaires were filled out at preprocedure and postprocedure 2 weeks, 6 months, and 1 year. Reduction of analgesic treatment and the patients' satisfaction were also recorded. METHODS: All procedures were performed under local anesthesia and fluoroscopic guidance on an outpatient basis. Patients underwent discography to evaluate annular integrity just before nucleoplasty. Channels were created in the nucleus by advancing the radiofrequency probe (ablating) and withdrawing it (coagulation). In all patients six channels were created. RESULTS: Thirty-four patients had one and 18 had two discs treated; a total of 70 procedures were performed. Mean age of patients was 44.8 +/- 8.6 years. The mean follow-up period was 12.1 +/- 1.6 months. Mean VAS reduced from preprocedure 7.5 to 3.1 at postprocedure 6 months and to 2.1 at the latest follow-up. Mean Oswestry index decreased from 42.2 to 24.8 at 6 months and to 20.5 at the latest examination. Analgesic consumption was stopped or reduced in 42 patients (85%) at 6 months and in 46 patients (94%) 1 year after the procedure. Overall patient satisfaction was 81% at 2 weeks, 85% at 6 months, and 88% at the latest follow-up. There were no complications related to the procedures. CONCLUSIONS: Our results encourage us to use nucleoplasty in carefully selected patients with leg pain caused by radicular encroachment. We recommend applying this minimally invasive technique only in those patients with small (<6 mm) contained disc herniations, with a disc height of >= 50% and with annular integrity. (C) 2007 Elsevier Inc. All rights reserved.Item Effects of levosimendan and dobutamine on experimental acute lung injury in ratsErbüyün, K; Vatansever, S; Tok, D; Ok, G; Turköz, E; Aydede, H; Erhan, Y; Tekin, IThe 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-1 beta immunolabelling in lung tissue; marked IL-1 beta immunolabelling was demonstrated in the dobutamine group. TNF-alpha 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. (C) 2008 Elsevier GmbH. All rights reserved.Item Effect of propofol and clonidine on cerebral blood flow velocity and carbon dioxide reactivity in the middle cerebral arteryMirzai, H; Tekin, I; Tarhan, S; Ok, G; Goktan, CThis 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 (CO,) response by using transcranial Doppler ultrasonography. Mean Vmca in response to changes in arterial partial pressure of CO2 (Paco(2)) was determined under the following conditions: awake (group 1), propofol anesthesia (group 2), and combined propofolclonidine anesthesia (group 3). Nonnocapnic, hypercapnic, and hypocapnic values of heart rate, mean arterial pressure, partial end-tidal CO2 pressure, Paco(2), and Vmca were obtained. The mean Vmca in groups 2 and 3 was significantly lower than that in group 1 at each level of Paco(2). The calculated Vmca at each level of Paco(2) was not different between groups 2 and 3. There was a correlation between Paco(2), and Vmca in all groups, but in the anesthetized groups the effect of Paco(2) on Vinca 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 A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint painTekin, I; Mirzai, H; Ok, G; Erbuyun, K; Vatansever, DObjectives: 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 degrees 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 PRIF 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 PRIF 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.Item Levosimendan up-regulates transforming growth factor-beta and Smad signaling in the aorta in the early stage of sepsisErbüyün, K; Tok, D; Vatansever, S; Ok, G; Türköz, E; Aydede, H; Erhan, Y; Tekin, IBACKGROUND This prospective, controlled experimental study was planned to investigate the effects of levosimendan on transforming growth factor (TGF)-beta 3 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 mu g.kg(-1)min(-1) intravenous (IV) dobutamine infusion, 3) levosimendan group - as in 2, then treated with levosimendan IV bolus 200 mu g.kg(-1) followed by 200 mu g.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)-alpha was mild in both sham and control groups. TGF-beta 3 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-beta 3 and Smad1, Smad2 and Smad3 expression.Item Effect of Anaesthesia Methods for Regaining Daily Life Activities in Cesarean PatientsGürsoy, C; Ok, G; Aydin, D; Eser, E; Erbüyün, K; Tekin, I; Baytur, Y; Uyar, YObjective: Postpartum period is physically, socially and emotionally a difficult time for the parents and the baby to become a family. We tried to investigate how the anaesthesia method affects patients who underwent cesarean delivery, as a factor which also affects this period. Methods: Two hundred and six parturients, who underwent elective cesarean delivery in Celal Bayar University Hafsa Sultan Hospital were recruited for our study. After demographic data and anaesthesia methods were noted, an EQ-5D health survey and Katz ADL scale were evaluated face to face 24 hours postoperatively, and by telephone on the 5th postoperative day. Results: The percentage of patients who had general anaesthesia was 35.2% (n=71), while 19.8% (n=40) had epidural anaesthesia and 45% (n=91) had spinal anaesthesia. Among -these three methods, the EQ-5D health survey revealed that the outcome at postoperative 24 hours was best in epidural anaesthesia and that general anaesthesia outcome was the worst (p=0.007). The Katz ADL scale at postoperative 24. hours showed that epidural anaesthesia was better than the other methods for regaining daily life activities (p< 0.05). Conclusion: Our study showed that epidural anaesthesia had the most effective role among the methods in regaining daily life activities after elective cesarean delivery, which was demonstrated using the EQ-5D health survey and Katz ADL scale.