Browsing by Author "Toprak V."
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Item The effects of magnesium sulphate on postoperative analgesia; [Magnezyum sulfatin postoperatif analjeziye etkileri](2000) Tekin I.; Erbuyun K.; Oruc S.; Toprak V.; Alincak H.It has been suggested that magnesium with its calcium channel blocking and NMDA antagonist properties could play a role in prevention and treatment of pain. We assessed the effect of perioperative IV magnesium sulfate on the early period of postoperative analgesia. ASA I or II class, at least graduated from secondary school, 30 patients, undergoing elective abdominal hysterectomy with TIVA (total intravenous anaesthesia), received standard premedication. We added saline (group I, n:15) or 15 % MgS04 (group II, n:15), 15 mL IV bolus after induction agents and 3 mL/h IV infusion at the end of the postoperative 6th hour. PCA (patient controlled analgesia) with fentanyl was used for postoperative analgeesia. Peroperative hemodynamic data, total propofol, fentanyl and vecuronium doses are noted. VAS (visuel analog scale) was used to assess postoperative pain and sedation scale for sedation assessment in postoperative 30. minutes and 2-4-6. hours. Determination of serum magnesium-concentration were obtained before the start Of the intravenous study drug treatment and after the end of the infusion. There were no differences in demographic data, ASA classification, duration of surgery, intraoperatif total propofol, fentanyl and vecuronium doses between two groups. Postoperative demand, delivery and total fentanyl levels were higher in group I (p<0.05). VAS and SS were similar in two groups. At the end of the infusion serum magnesium concentrations were higher than preoperative values in group II (p<0.05). In this study we found that magnesium-reduces postoperative analgesic requirements without adverse effects. In conclusion, magnesium is a good adjuan analgesic agent and will gain a popularity in the early future with new studies.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 A histological analysis of the protective effect of ischemic preconditioning in the rat retina(2002) Toprak A.B.; Ozbilgin K.; Toprak V.; Tuglu I.; Guler C.Purpose. Ischemic preconditioning (IP) protects the retina from the damaging effect of subsequent ischemia in vivo. We aimed to investigate the histological alterations induced by the protective effect of IP to the retina. Methods. The eyes of the rats were rendered ischemic by intra-ocular pressure (IOP) elevation. IP procedure consisted of producing ischemia for 5 minutes. Sham operation was similar to IP procedure except the pressure elevation. The operational eyes of sham and IP group underwent 60 minutes of ischemia 24 hours after the first procedure. The eyes contralateral to the experimental eyes made up the control group. The eyes were histologically analysed one week after the ischemia. Results. The total retinal thickness of the sham group was significantly less than total retinal thickness of the control group (p < 0.001). There was not a significant difference between control and IP group regarding the total retinal thickness (p > 0.05). The thickness of the inner retinal layers of the sham group were significantly less than corresponding retinal layers of the control group (p < 0.001). The inner plexiform layer (IPL) and inner nuclear layer (INL) thickness values of the sham group were significantly less than same layers of the IP group (p < 0.001). Ganglion cell layer (GCL) thickness of the IP group was significantly less than GCL thickness of the control group (p < 0.001). IPL thickness of the IP group was significantly less than that of control group's (p < 0.05). The GCL and total retinal thickness of the IP group were significantly more than thickness of the corresponding layers of the sham group (p < 0.05). Conclusion. IP considerably protects inner retinal layers from subsequent ischemic damage in a high IOP ischemic model. This endogenous process could further be utilized to tailor specific neuroprotective strategies for retinal cells.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 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 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 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 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 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 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 Evaluation of parents' anxiety concerning the post-operative period following pediatric ambulatory surgery; [Pediyatrik Günübirlik Cerrahide Ebeveynlerin Postoperatif Dönem Hakkindaki Endişelerinin Deǧerlendirilmesi](2005) Tezcan Keleş G.; Toprak V.; Topaloǧlu K.; Ok D.In the present study, we aimed to determine what anxieties parents have concerning the postoperative period following pediatric ambulatory surgery. After obtaining approval from the Institutional Ethics Committee and the parents' informed consent, 100 parents were evaluated with a questionnaire. Parents scored their anxiety regarding potential postoperative problems that children may encounter: such as pain, nausea, vomiting, disorientation, shivering, sore throat, drowsiness, and thirst. Parents assessed each item on a 1 to 10 point scale. A score of "1" represented the "least upsetting condition" and "10" represented "most upsetting condition". Pain was scored with the highest point (7.32 ± 3.09) by the parents. Parents with higher education showed greater concern regarding items related to thirst (5.31 ± 3.96 point, p<0.02) and disorientation (4.51 ± 3.83 points, p<0.008). In the others section, unsuccessful surgery (4.38 ± 4.70 point) and unnecessary intervention (3.43 ± 4.40 point) were taken part. As a conclusion, parents must be informed sufficiently about potential problems and anesthesiologist and surgeon cooperation during the preoperative evaluation period is essential.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 The effect of levosimendan on weaning from cardiopulmonary bypass and early hemodynamic parameters in patients with compromised left ventricular function; [Kötü sol ventrikül fonksiyonlu hastalarda levosimendanin kardiyopulmoner baypastan ayrilma ve erken dönem hemodinamik parametreler Üzerine etkileri](2006) Öztürk T.; Şirin H.; Toprak V.; Ertan Y.; Cerrahoǧlu M.In this study we determined the effects of levosimendan on hemodynamic parameters during weaning from cardiopulmonary bypass (CPB) and in the early postoperative period in patients with compromised left ventricular-function. Charts of 18 patients with an ejection fraction of ≤30 % who underwent elective coronary artery bypass (CABG) surgery were reviewed. Eight (Group L) had received a loading dose of levosimendan (6 μg kg-1) within 10 minutes after removal of the cross clamp, followed by an infusion (0.1 mcg kg-1 min-1). Control patients (n=10, Group C) received dopamine, dobutamine or adrenaline. Hemodynamic parameters during the early postoperative period were compared. Cardiac index (CI) was significantly higher than baseline in both groups at one and six hours after removal of the cross clamp (p<0.05). CI was significantly greater, and SVRI and PVRI were significantly lower, in Group L at both one and six hours (p<0.001). In conclusion, the use of levosimendan was associated with more favourable hemodynamic effects in patients with compromised left ventricular function during weaning from CPB and in the early postoperative period after CABG surgery.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 A summary of cases of central venous catheterization in infants; [Infantlarda santral venöz kateterizasyon deneyimlerimiz](2007) Toprak V.; Topçu I.; Tezcan Keleş G.Objective: The purpose of this study is to analyze the features of central venous catheterization (CVC) procedures, retrospective evaluation of the problems observed during catheter insertion up until its withdrawal of them and discuss the results according to the literature in infant cases. Method: Between March 2004 and May 2005, central venous catheters administered to 27 infants by consultant anesthesiologists for follow-up in non-cardiac surgery and Pediatric Intensive Care Unit were evaluated retrospectively with demographic data, primary disease, the place of catheterization and complications. Results: Thirteen of the cases (48.1 %) were younger than 6 months and the rest (51.9%) were older than 6 Months. Sixteen of the infants (59.3%) were female and 11 (40.7%) were male. Fifteen CVC (55.6%) were administered into the internal jugular vein and 12 (44.4%) into the subclavian vein. The mean catheterization time was 5.9±52 days. Arterial punctures during catheterization were observed in 3 of the cases (11.1 %). There was no relationship between arterial puncture and the place of catheterization or the age of infants. Blood could be aspirated in 15 (55.6%) of the infants. There was no relationship between administration site and blood aspiration (p>0.05). Conclusion: In pediatric patients, the complications of CVCs are closely related to age, body size and the experience of the anesthesiologist. The optimum administration place depends on the experience of the anesthesiologist and the clinical condition of the case.Item Hepatobiliary insufficiency-candidate of transplantation newborns and anesthesia (two cases); [Hepatobilier yetmezlikli-transplantasyon adayi neonatal olgular ve anestezi](2008) Öztürk T.; Bulut S.; Toprak V.; Tezcan Keleş G.Biliary atresia (BA) is the most common and important neonatal hepatobiliary disorder and is seen in 1 in 8.000 to 1 in 18.000. Consequently, 70-80 % of BA patients will eventually require liver transplantation, approximately half in the first 2 y of life. Early diagnosis and therapy is essential especially for the survival of patients with biliary atresia.