Browsing by Author "Tok D."
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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 Assessment of in-hospital cardiopulmonary resuscitation using utstein template in a university hospital(2004) Tok D.; Keleş G.T.; Toprak V.; Topcu I.The aim of this study was to evaluate the effectiveness of in-hospital cardiopulmonary resuscitation (CPR) strategies and identify key predictors of post-CPR survival in a university hospital setting. Using a form recommended by the European Resuscitation Council, data regarding in-hospital CPR attempts from January 2001 to December 2002 were recorded and analyzed. The main outcomes of interest were immediate survival after CPR and survival to hospital discharge. Of 307 patients who suffered cardiac arrest in the study period, 103 (33.5%) were resuscitated. Of these 103 patients, 28 (27.2%) survived immediately and 12 (11.7%) survived to hospital discharge. The key predictors of immediate survival were CPR duration and initial cardiac rhythm as monitored by ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The key predictors of survival to hospital discharge were CPR duration, immediate defibrillation, Glasgow Coma Scale score, and Early Prediction Score. Together, our results suggest that in-hospital CPR strategies require improvement. They also underscore the importance of data collection and analysis in evaluating the effectiveness of in-hospital CPR strategies. © 2004 Tohoku University Medical Press.Item Basic life support skills of doctors in a hospital resuscitation team(2004) Tok D.; Tezcan Keleş G.; Taşyüz T.; Yentür E.A.; Toprak V.The aim of the present study was to evaluate the basic life support skills of doctors in a hospital resuscitation team and to identify potential factors affecting those skills. Twelve anesthesiology residents were induced in this study. Each doctor was asked to perform mouth-to-mouth ventilation for 10 minutes and then chest compression for another 10 minutes on a Laerdal Skillmeter Resusci-Anne manikin during the day (10 am) and at night (10 pm). The rates of correct ventilation, correct chest compression, ventilation errors (i.e., excessive inflation, stomach insufflation, insufficient ventilation), and compression errors (i.e., insufficient chest compression/decompression, excessive chest compression, incorrect hand placement) were determined for each 2-min interval up to 10 min. In addition, effects of sex, seniority, CPR duration, and time of day (day vs night) on those skills were assessed. The mean rates of correct ventilation were 53.3±23.9% (day) and 60.4±16% (night); the mean rates of correct chest compression, 76.9±15% (day) and 76.5±14.7% (night). During the first 2-minutes period of testing at night, men doctors more frequently achieved correct ventilation than did women doctors (p<0.05). Overall, the practical CPR skills of the study participants were not influenced by sex, seniority, CPR duration, or time of day; however, the participants' skills were poor. This suggests that all medical staff, especially members of in-hospital resuscitation teams, should undergo regular, periodic CPR training. © 2004 Tohoku University Medical Press.Item Subanalgesic doses of ketamine and morphine but not morphine alone, prolong the sensory block time of hyperbaric bupivacaine in unilateral spinal anaesthesia(2004) Yentür E.A.; Tok D.; Keleş G.T.; Toprak V.; Aslan F.Aim: In this study, we aimed to compare the sensory and motor effects of a subanalgesic dose of morphine and morphine + ketamine added to 5% hyperbaric bupivacaine (HB) in unilateral spinal anaesthesia. Methods: 45 patients were randomly assigned to one of three groups. The first group received 1.5 ml 0.5% HB + 0.2 ml saline; the second group received 1.5 ml 0.5% HB + 0.1 ml morphine (0.1 mg) + 0.1 ml saline; the third group received 1.5 ml 0.5% HB + 0.1 ml ketamine (0.5 mg) + 0.1 ml morphine (0.1 mg). Maximum block levels, time to reach that level, time to reach T10 level and block levels after 120 min were recorded. Results: Maximum sensory and motor block levels, time to reach these levels and time to reach T10 level were similar in all three groups, but there was less regression of sensory block level in the third group than in the other two groups. Conclusion: Subanalgesic doses of morphine and ketamine added to 0.5% HB extended the sensory block period but not the motor block in unilateral spinal anaesthesia.Item Subcutaneous emphysema following severe vomiting after emerging from general anesthesia(2004) Toprak V.; Keles G.T.; Kaygisiz Z.; Tok D.Postoperative nausea and vomiting-related subcutaneous emphysema is an unexpected complication, especially after uneventful surgery and anesthesia. Here we report and discuss two cases of subcutaneous emphysema following severe retching and vomiting which resolved spontaneously after several days.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 What factors are related to patients' anaesthesia related anxiety during the post operative period?; [Postoperatif dönemde hastalarin anestezi konusundaki endişeleri nelerdir?](2005) Tezcan-Keleş G.; Toprak V.; Kefi A.; Tok D.Aim: We aimed to determine factors causing anxiety immediately and 24 hours after surgery in patients undergoing general anaesthesia. Material and Methods: Following the Institutional Ethics Committee approval and informed consent, 173 eases were studied. A standard evaluation form rated patient anxiety about postoperative pain, nausea, vomiting, disorientation, shivering, sore throat, drowsiness, thirst, gagging on the tracheal tube and awareness during anaesthesia. Anxiety was rated using a 1 to 10 point verbal "numeric anxiety scale". (NAS) where a score of "1" represented "least upsetting condition" and "10" represented the "most upsetting condition". Results: Pain caused the most anxiety (immediately postoperative NAS=4.6±3.6 increasing to 5.8±3.7 on postoperative day one. Awareness during anaesthesia (3.2+4.0), sore throat (2.8±3.4), disorientation (2.5±3.5) and drowsiness (2.1±2.9) were other major eauses of anxiety. While the increase in anxiety related to pain increased significantly on postoperative day one, there was a decreased in changes in the other factors over this time. Conclusion: Postoperative pain is the most common anaesthesia-related factor causing anxiety in patients undergoing general anaesthesia. This finding underscores the importance of detailed preoperative communication with patients regarding their perioperative pain management.Item The effect of combination of sevoflurane and desflurane with fentanyl and remifentanil on different recovery scores in outpatient anesthesia; [Günübirlik Anestezide Sevofluran Veya Desfluran Ile Birlikte Fentanil ve Remifentanil Kombinasyonunun Farkli Derlenme Skorlari Ile Karşilaştirilmasi](2005) Tezcan Keleş G.; Toprak V.; Ekici Z.; Tok D.We aim to compare sevoflurane and desflurane with fentanil and remifentanil in the operating room (OR-Phase-1) and post-anaesthesia care unit (PACU-Phase-2) by using Fast-Tract-Criteria (FTC) and Aldrete Criteria (AC) for ambulatory anesthesia. After obtaining approval from the Faculty Ethics Committee, 80 ASA I-II patients, aged 18-60 were randomly divided into four groups (n=20). Following standard anaesthesia induction, Group (S+F) received 1-3 % sevoflurane + 2 μg kg-1h-1 fentanyl, Group (S+R) received 1-3% sevoflurane + 0.25 μg kg-1h-1 remifentanil, Group (D+F) received 2-5 % desflurane + 2 μg kg-1h-1 fentanyl and Group (D+R) received 2-5% desflurane + 0.25 μg kg-1h-1 remifentanil in 60% N2O for anaesthesia management. Fifteen minutes before the end of the surgery, standard analgesic and anti-emetic medications were applied to all patients. Extubation times were recorded, FTC and AC were evaluated in the OR at the 5th and 10th minutes following extubation and in PACU at the 5th, 15th and 25th minutes. Pain and emesis were evaluated in the PACU. P<0.05 was considered significant. In phase 1 at the 10th min; Group (D+R) had a higher AC score than group (S+F) (p<0.05), in phase 2 at the 5th min; Group (D+R) had higher FTC and AC scores than the other groups (p<0.01 and p<0.05). In phase 2 at the 15th minute, Group (S+F) had a lower AC score than the other groups (p<0.05). In all patients, targeted discharge points were achieved at the 25th minute in PACU. In conclusion, both FTC and AC were applied easily in Phase 1 and Phase 2 to the four groups. The desflurane and remifentanil combination seems to be the most suitable for outpatient anesthesia.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 Comparison of antimicrobial effects of dexmedetomidine and etomidate-lipuro with those of propofol and midazolam(2006) Keleş G.T.; Kurutepe S.; Tok D.; Gazi H.; Dinç G.Background and objectives: The aim of our study was to investigate the antimicrobial effects of dexmedetomidine and etomidate-lipuro, and to compare these effects with those of midazolam and propofol on Staphylococcus aureus, Escherichia coli, Pseudomonas aeroginosa, Acinetobacter baumannii and extended-spectrum beta-lactamase Escherichia coli ( E. coli ESBL). Methods: All hypnotic dilutions were exposed to micro-organisms for 0, 30, 60, 120 and 240 min at room temperature in vitro. The inoculums taken from diluted suspensions were re-inoculated on blood agar and incubated for 18-24 h at 35°C after which a count of the colonies was compared. Results: Midazolam reduced the viable cells of S. aureus at 30, 60, 120 and 240 min, and also completely inhibited the growth of E. coli, P. aeroginosa, A. baumannii and E. coli ESBL. Dexmedetomidine, etomidate-lipuro and propofol, however, did not inhibit any of the micro-organisms tested. Conclusion: In vitro, midazolam had an antimicrobial effect on E. coli, P. aeroginosa, A. baumannii and E. coli ESBL. Like propofol and dexmedetomidine, etomidate-lipuro had no antimicrobial effect on any of the micro-organisms tested. © 2006 Copyright European Society of Anaesthesiology.Item The effect of cardiopulmonary bypass on the expression of inducible nitric oxide synthase, endothelial nitric oxide synthase, and vascular endothelial growth factor in the internal mammary artery(2006) Toprak V.; Şirin B.H.; Tok D.; Özbilgin K.; Saribülbül O.Objective: Endothelial function of a vessel may be impaired by local or systemic inflammation initiated by cardiopulmonary bypass (CPB) during coronary artery bypass graft (CABG) surgery. The present study was designed to investigate the early effects of CPB on nitric oxide production and vascular endothelial growth factor (VEGF) expression in internal mammary artery (IMA). Design: Prospective study. Setting: University hospital. Participants: Twenty patients who were scheduled for elective CABG with CPB. Interventions: IMA sections were studied immunohistochemically from these patients. The samples were taken from the distal end of the IMA before the institution of CPB and just before the construction of the IMA-left anterior descending artery anastomosis. Measurement and Main Results: After CPB, VEGF and endothelial nitric oxide synthase immunoreactivity increased significantly when compared with baseline values in the endothelium (p = 0.0156, p = 0.0313) and adventitia (p = 0.0313, p = 0.0001), respectively. No significant change was observed in inducible nitric oxide synthase immunoreactivity. Conclusions: The increase in eNOS expression may have been induced by the inflammation caused by CPB. © 2006 Elsevier Inc. All rights reserved.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 Chronic pain after Lichtenstein and preperitoneal (posterior) hernia repair(Canadian Medical Association, 2008) Erhan Y.; Erhan E.; Aydede H.; Mercan M.; Tok D.Background: Hernia repair is one of the most common surgical procedures, and some patients suffer from chronic pain after hernia surgery. The aim of the present study was to evaluate chronic postherniorrhaphy pain in men who underwent Lichtenstein mesh repair or preperitoneal (posterior) repair. Methods: Our study included 94 male inpatients. Two surgeons experienced in both Lichtenstein and preperitoneal hernia repair performed the procedures. We controlled postoperative pain with systemic analgesic therapy. We evaluated the patients over the subsequent 12 months, using a questionnaire to focus on chronic pain and its limitations to their quality of life. Results: The overall incidence of chronic pain at 2 months was 5%. About 6% of patients who underwent Lichtenstein repair (n = 70) and 4% of patients who underwent preperitoneal repair (n = 24) experienced chronic pain. All patients with chronic pain rated their pain as slight or moderate. Their pain was present occasionally and was related to physical stress. None of the patients were unable to work. After 12 months of follow-up, the overall incidence of chronic pain decreased to 3%, with 3 patients in Lichtenstein group reporting chronic pain with slight limitations in sports and social activities. Conclusion: The incidence rates of chronic pain after Lichtenstein and preperitoneal repair were 6% and 4%, respectively. Inpatient status might have resulted in low incidences with both approaches. © 2008 Canadian Medical Association.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 The effect of remifentanil on the emergence characteristics of children undergoing FBO for bronchoalveolar lavage with sevoflurane anaesthesia(2009) Ozturk T.; Erbuyun K.; Keles G.T.; Ozer M.; Yuksel H.; Tok D.Background and objective The aim of this study was to compare the effects of sevoflurane vs. sevoflurane and remifentanil on cough and agitation during emergence and recovery after fiberoptic bronchoscopy. Methods Children between 2 and 6 years of age undergoing fiberoptic bronchoscopy were enrolled. All patients were premedicated with oral midazolam. Patients were randomly assigned to either group S (sevoflurane alone, n = 25) or group SR (sevoflurane with remifetanil, n = 25). Anaesthesia was induced and maintained with sevoflurane in all patients. Group SR received remifentanil at a bolus dose of 1 μg/kg over 2 min followed by a maintenance infusion of 0.15 μg/kg/min. In addition to routine anaesthesia documentation, agitation scores and cough scores were recorded every 5 min during emergence and recovery. Results Duration of the procedure, anaesthesia and emergence phases was similar in both groups (P>0.05). Time until recovery was significantly shorter in group SR than in group S (7.0 ± 5.5 min and 13.0 ± 3.5 min, respectively; P = 0.001). Cough scores were not significantly different between the two groups during emergence and recovery (Kruskal-Wallis ANOVA test, P0.05). However, the mean agitation score at 5 min in group SR was significantly higher than that in group S (Kruskal-Wallis ANOVA test, P<0.01). One case of hypoxaemia from thoracic rigidity occurred in a patient in group SR. Conclusion The addition of remifentanil significantly shortened recovery time in children undergoing fiberoptic bronchoscopy under sevoflurane anaesthesia. In the recovery period, remifentanil did not decrease cough, and increased agitation. © 2009 European Society of Anaesthesiology.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.