MCBÜ Açıkerişim Sistemi :: Browsing by Subject "general anesthesia"

Browsing by Subject "general anesthesia"

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Postoperative analgesic effects of intraarticular morphine and neostigmine after arthroscopy
(2002) Tekin I.; Ongun B.; Kafesçiler K.
Postoperative analgesic effect of intraarticular morphine and neostigmine after arthroscopy were compared. We studied 60 patients, undergoing elective knee arthroscopy. A standardized general anesthetic was administered. Patients were allocated to 3 groups at the end of the surgery. Group K (control, n=20) recieved 20 mL 0.9% saline, group M (morphine, n=20) recieved 1 mg morphine in 20 mL 0.9% saline and Group N (neostigmine. n=20) recieved 0.5 mg neostigmine in 20 mL 0.9% saline intraarticularly, 10 minutes before the limb tourniquet was deflated. Postoperative pain scores were recorded at the end of the surgery, at 30. min, 1., 2., 4., 6. and 12. hours postoperatively by VAS. Heart rate, mean arterial pressure, breathing rate and adverse effects were also recorded at the same times. Additional analgesic requirements, total analgesic consumption and first analgesic administration time were settled. There were no significant differences in hemodynamic parameters and additional analgesic requirements between the Group M and Group N. VAS scores on flexion and extention were significantly lower in group M and N compared with group K at postop 30. min. At subsequent measurements, VAS scores on extention were lower in group M and N according to group K. Additional analgesic administration was very high in group K, compared with the othe groups. First analgesic administration time was not different between Group M and N. Patients didn't complain from any adverse effects. Finally, we conclude that İntraarticular low-dose (1 mg) morphine and 0.5 mg neostigmine produce significant analgesic effect compared with placebo but they are not superior each other.
The effect of tibolone on endometrial IGF-1 and IGFBP-1 levels in ovariectomized rats
(2002) Kuşcu N.K.; Koyuncu F.M.; Inan S.; Tuglu I.; Uyar Y.; Ozbilgin K.
Objective: The goal of this study was to search the effects of two different doses of tibolone on endometrial IGF-1 and IGFBP-1 levels in ovariectomized rats. Methods: Eighteen adult, female, 80-90-days-old, Wistar rats with an average weight of 250 g underwent bilateral ovariectomy under general anesthesia. After waiting for 4 weeks, they were randomized into three groups to receive either oral tibolone in two different doses or placebo. The treatment was continued for 5 weeks, and then the rats were sacrificed and the endometria were analyzed. Results: Low columnar epithelium of the endometrial surface, longer epithelium and stratified squamous epithelium were seen in the control, low-dose and high-dose groups, respectively. The staining intensity of IGF-1 was mild in control, and moderate in both treatment groups, the difference between control the treatment groups was significant (P=0.015 for group L, and P=0.03 for group H). The staining intensity of IGFBP-1 was moderate in control, and strong in groups L and H. Again the difference was significant between control and both treatment groups (P=0.039 for grup L, and P=0.03 for group H). No significant difference was noted between each treatment group for both IGF-1 and IGFBP-1. Conclusion: Tibolone caused histological changes in endometrium and stimulated IGF-1 and IGFBP-1 staining. Both low and high dose treatments led to moderate and strong staining intensities for IGF-1 and IGFBP-1, respectively. The strong staining intensity of IGFBP-1 is likely due to the progestagenic effect of tibolone. © 2002 Elsevier Science Ireland Ltd. All rights reserved.
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.
Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery: A randomized controlled trial
(2002) Mirzai H.; Tekin I.; Alincak H.
Study 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 A2, 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 and 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.
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.
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.
Different anesthesiologic strategies have no effect on neonatal jaundice.
(2004) Ozcakir H.T.; Lacin S.; Baytur Y.B.; Lüleci N.; Inceboz U.S.
OBJECTIVE: In this prospective study, we examined the influence of either segmental epidural anesthesia with bupivocaine hydrochloride or general anesthesia with sevoflurane on serum bilirubin levels and jaundice in neonates born with caesarean section. MATERIALS AND METHODS: The patients at 38-40 weeks were included into this prospective study. General anesthesia group (sevoflurane); Group A, (n=66) and segmental epidural anesthesia group (bupivocaine hydrochloride); Group B, (n=76) underwent caesarean section under elective circumstances. Neonatal serum bilirubin levels were determined at the ages of 24 h and 5 days in 142 infants. The sexuality, weight, 5th minute APGAR scores, hematocrit levels of the neonates were recorded. The neonates who needed phototherapy were also noted. The results in Group A and Group B were compared. RESULTS: There was no significant difference on bilirubin levels between two groups and the incidence of hyperbilirubinemia did not differ statistically (p>0.05). The percent of the newborns who needed phototherapy displayed no significant differences between the deliveries by caesarean section under general or segmental epidural anesthesia. CONCLUSION: Our findings support the clinical studies which have not demonstrated an association between different anesthesiologic strategies and neonatal jaundice.
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.
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.
Comparison of propofol and sevoflurane anesthesia by means of blood loss during endoscopic sinus surgery
(2004) Sivaci R.; Yilmaz M.D.; Balci C.; Erincler T.; Unlu H.
Objective: The purpose of the present investigation is to examine whether induced hypotension with propofol or sevoflurane anesthesia improves the dryness of surgical field in endoscopic sinus surgery (ESS). Methods: The study was performed between 1999 and 2002 in Celal Bayar University and Afyon Kocatepe University Hospitals, Turkey. Thirty-two patients (American Society of Anesthesiologists physical status I and III) with chronic sinusitis undergoing outpatient endoscopic sinus surgery under general anesthesia were studied to determine if anesthetic technique had an impact on estimated blood loss. The patients were allocated randomly into 2 groups. None of the patients were premedicated. Anesthesia was induced with propofol in both groups and maintained with propofol/fentanyl in the first group and sevoflurane/fentanyl in the second group. In both groups, controlled hypotension was used to improve surgical condition. Results: There were no differences between the duration of surgery and intraoperative mean arterial blood pressure when comparing the 2 groups. The average estimated blood loss in the propofol group was 128.1 ± 37.3 ml compared with an average estimated blood loss of 296.9 ± 97.8 ml in the sevoflurane group (p<0.01). Conclusion: General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents. Therefore, making endoscopic surgery technically easier and safer by improving endoscopic visualization of the surgical field.
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.
Comparison of analgesic activity of the addition to neostigmine and fentanyl to bupivacaine in postoperative epidural analgesia
(2006) Tekin S.; Topcu I.; Ekici N.Z.; Caglar H.; Erincler T.
Objectives: To compare the analgesic and side effects of bupivacaine in combinations with neostigmine and fentanyl using patient-controlled-epidural analgesia (PCEA) methods in the postoperative period after abdominal hysterectomy. Methods: Seventy-five adult American Society of Anesthesiologists physical status I-II patients, aged 18-65 years were included in the study. The study took place in Celal Bayar University Hospital, Turkey between 2003-2004 years. After preoperative epidural catheterization, the patients were operated under general anesthesia. After surgery, the patients were randomly allocated in a double-blinded manner to receive PCEA and divided into 3 groups: Group B: 0.125% bupivacaine, Group N: 0.125% bupivacaine plus neostigmine 4 μg kg-1 and Group F: 0.125% bupivacaine plus 1 μg kg-1 fentanyl solutions (10 mL loading dose, 5 mL bolus dose, 10 min lockout time, 30 mL in 4 hour limit). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale, total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated. Results: Total analgesic consumption was 143.7 ± 7.2 mL in Group B, 123.4 ± 6.2 mL in Group N and 106 ± 8.3 mL in Groups F. The mean value in Group F was significantly lower than Group N and Group B (p<0.05), and was lower in Group N than Group B. Visual analog scale scores were lower in Group F than other groups (p<0.05). There were no differences in side effects between all groups. Conclusions: Fentanyl and neostigmine by the PCEA method can be used safely for postoperative analgesia after gynecologic surgery. They increase analgesia quality and satisfaction without an increase in side effects.
Clinical and radiologic evaluations for predicting difficult tracheal intubation; [Valutazioni cliniche e radiologiche per prevedere l'intubazione tracheale difficile]
(2006) Topcu I.; Ovali G.Y.; Yentur E.A.; Kefi A.; Tuncyurek O.; Pabuscu Y.
Objective: The aim of this study is to predict difficult endotracheal intubations preoperatively with clinical and radiographical parameters (lateral x-ray) and to assess their reliability. Design: 208 adult patients (68 male, 140 female) submitted for elective surgery under general anaesthesia were included into this study. Age, height, weight, inter-incisor gap, neck circumference, sternomental and thyromental distance, modified Mallampati classification and protruding upper teeth were measured during preoperative evaluation. Lateral cervical spine radiographs were evaluated to predict the skeletal structure associated with difficult intubation. Laryngeal view was graded according to Cormack-Lehane laryngoscopic classification. The number and duration of attempts at each tracheal intubation were recorded. Results: We obtained the percentage of difficult intubations to be 5.7%. There was no significant association between difficult intubation and age, weight, thyromental and sternomental distances, mandibular protrusion, Wilson risk scores, inter-incisor gap and neck circumference (p > 0.05). Difficult intubations were associated with male sex, Cormack-Lehane grade 3 or 4 and two and more increased Mallampati grade (p < 0.05). After taking the measurements on the radiographs, we observed a significant association between temporomandibular joint (TMJ) to tip of upper incisors (V1), length of the perpendicular from the hard palate to the tip of the upper incisors (V2), TMJ to tip of lower incisors (V5), the distance from the upper incisors to the corniculate cartilages (V17), the anteroposterior thickness of the tongue (V19) for difficult intubation with stepwise multivariate logistic regression model (p < 0.05). According to Cormack-Lehane classification we calculated the highest sensitivity as (83.3%), specificity as (95.9%), positive predictive value as (55.6%) and negative predictive value as (98.9%). Conclusion: We conclude that these clinical and radiographic measurements are of little value in predicting difficult intubation in adults when used alone. For elective cases, we advocate taking additional radiological examinations, if clinical findings predict or indicate the probability of a difficult airway.
A comparison of bupivacaine, bupivacaine-fentanyl and bupivacaine-ketamine in patient-controlled epidural analgesia; [Hasta Kontrollü Analjezi̇de Epi̇dural Bupi̇vakȧin Bupi̇vakai̇n-Fentani̇l ve Bupi̇vakai̇n-Ketaṁiṅin Etki̇leri̇ni̇n Karşilaştirilmasi]
(2006) Tekin S.G.; Topçu I.; Kefi A.; Enrinçler T.
Background: In this study, the analgesic and side effects of bupivacaine with combinations of ketamine and fentanyl using patient-controlled-epidural analgesia (PLEA) methods in the postoperative period of total abdominal hysterectomy (TAH) operations were compared. Method: Sixty ASA I-II patients aged between 18-65 years were included, Following epidural catheterization the patients were operated under general anesthesia, After surgery, patients were randomly allocated to 3 groups in a double-blinded fashion to receive PCEA as Group B: 0.125% bupivacaine, Group BF: 0.125% bupivacaine plus 0.1 mg fentanyl and Group BK.: 0.125% bupivacaine plus 40 mg ketamine solutions (10 mL loading dose, 5 mL bolus dose, 10 min lockout time, 30 mL in a 4 hour limit) in 100 mL salin. Hemodynamic parameters, VAS scores, total analgesic consumption, additional analgesic requirements, sedation scores, satisfaction scores and probable side-effects were evaluated for 24 h. Results: Total analgesic consumption was lower in the fentanyl group (p<0.05), Therefore VAS scores in the fentanyl group were lower than the other groups at the 1 hour and the 24 hour assessments (p<0.05), Postoperative analgesic consumption was lower in the ketamine group compared to the control group, There was no difference in side effects and additional analgesic requirement between the groups. Conclusion: Fentanyl and ketamine may be used safely by PCEA for postoperative analgesia, These adjuncts increase analgesic quality and patient satisfaction without increased side effects.
A case of congenital midline cervical cleft treated with single Z-plasty; [Z-plasti ile onarim yapilan konjenital orta hat servikal kleft olgusu]
(2007) Yilmaz Ö.; Genç A.; Demireli P.; Özcan T.; Taneli C.
Congenital midline cervical cleft (CMCC) is a rare developmental anomaly in the ventral aspect of the neck. The most excepted theories of embryologic development is impaired fusion of the distal branchial arches in the midline. If the lesion is remain untreated, it causes cicatrical contracture in the neck over time. For this reason complete excision is necessary. We present a case of CMCC treated with Z-plasty closure, because it is very rare. 3 day old male infant was brought to the hospital due to the lesion at his neck, and diagnosed as thyroglossal sinus and recommended to have an operation. When the patient presented to our clinic, his physical examination showed lineer cleft lined with atrophic pink epithelium on the ventral mid-cervical line. The patient underwent elliptically complete excision of the lesion at 3 months of age with intratracheal general anesthesia. The closure of the vertical deficiency was accomplished by single-Z-plasty. As, CMCC is reported as a rare abnormality diagnosis can be assess difficultly. Diagnosis and the treatment of this abnormality should be managed as soon as possible, in order to prevent the neck contracture highly likely to develop in the future.
Surgical treatment of displaced radial neck fractures in children with Metaizeau technique
(2007) Okçu G.; Aktuǧlu K.
BACKGROUND: The treatment of radial neck fractures in children is difficult when the angular displacement exceeds 30 degrees. The authors report their experience with closed reduction of this fracture and intramedullary pinning which was described and popularized by Metaizeau et al. in 1980. METHODS: Under general anesthesia and guidance of an image intensifier, a 1 cm incision was made on the radial side of distal radial metaphysis. A Kirschner wire was contoured and then the last 3-5 mm were bent approximately 30 degrees. It was introduced into the medullary canal of the radius and by pushing it proximally until its point reaches the inferior aspect of the epiphysis to elevate and rotate to achieve an anatomic reduction. This technique was used in nine patients between 1996 and 2003. RESULTS: Full functional recoveries with excellent results were observed in all cases but one at the last follow-up. No complication was encountered. CONCLUSION: We recommend this closed technique as it is relatively simple and associated with encouraging results.
A possible perianesthetic serotonin syndrome related to intrathecal fentanyl
(2008) Ozkardesler S.; Gurpinar T.; Akan M.; Koca U.; Sarikaya H.; Olmez T.; Elar Z.
Serotonin syndrome occurs with selective serotonin reuptake inhibitors, opioids, and other serotonergic agents. We describe a possible serotonin syndrome related to intrathecal fentanyl in a patient taking multiple drugs and substances such as ergot alkaloids, marijuana, methylenedioxy-N-methylamphetamine, and ephedrine. © 2008 Elsevier Inc. All rights reserved.
The effect of epidural and general anesthesia on newborn rectal temperature at elective cesarean section
(Associacao Brasileira de Divulgacao Cientifica, 2009) Yentur E.A.; Topcu I.; Ekici Z.; Ozturk T.; Keles G.T.; Civi M.
Both epidural and general anesthesia can impair thermoregulatory mechanisms during surgery. However, there is lack of information about the effects of different methods of anesthesia on newborn temperature. The purpose of this study was to determine whether there are differences in newborn rectal temperature related to type of anesthesia. Sixty-three pregnant women were randomly assigned to receive general or epidural anesthesia. Maternal core temperature was measured three times with a rectal probe just before anesthesia, at the beginning of surgery and at delivery. In addition, umbilical vein blood was sampled for pH. The rectal temperatures of the babies were recorded immediately after delivery, and Apgar scores were determined 1, 5, and 10 min after birth. The duration of anesthesia and the volume of intravenous fluid given during the procedure (833 ± 144 vs 420 ± 215 mL) were significantly higher in the epidural group than in the general anesthesia group (P < 0.0001). Maternal rectal temperatures were not different in both groups at all measurements. In contrast, newborn rectal temperatures were lower in the epidural anesthesia group than in the general anesthesia group (37.4 ± 0.3 vs 37.6 ± 0.3° C; P < 0.05) immediately after birth. Furthermore, the umbilical vein pH value (7.31 ± 0.05 vs 7.33 ± 0.01; P < 0.05) and Apgar scores at the 1st-min measurement (8.0 ± 0.9 vs 8.5 ± 0.7; P < 0.05) were lower in the epidural anesthesia group than in the general anesthesia group. Since epidural anesthesia requires more iv fluid infusion and a longer time for cesarean section, it involves a risk of a mild temperature reduction for the baby which, however, did not reach the limits of hypothermia.
Evaluation of piroxicam-β-cyclodextrin as a preemptive analgesic in functional endoscopic sinus surgery
(Associacao Brasileira de Divulgacao Cientifica, 2010) Keleş G.T.; Topçu I.; Ekici Z.; Yentür A.
The preemptive analgesic efficacy and adverse effects of preoperatively administered piroxicam-β-cyclodextrin for post-endoscopic sinus surgery pain was determined in a prospective, double-blind, randomized, clinical study. Seventy-five American Society of Anesthesiologists status I-II patients, aged 18-65 years, were divided into three groups with similar demographic characteristics: group 1 received 20 mg piroxicam-β-cyclodextrin, group 2 received 40 mg piroxicam-β-cyclodextrin and group 3 received placebo orally before induction of general anesthesia. A blinded observer recorded the incidence and severity of pain at admission to the post-anesthesia care unit (PACU), at 15, 30, and 45 min in the PACU, and 1, 2, 4, 6, and 24 h postoperatively. All patients received patient-controlled morphine analgesia during the postoperative period and consumption was recorded for 24 h. During the PACU period, mean visual analogue scale values were significantly lower in groups 1 and 2 compared to group 3 (P < 0.05). During the postoperative period, morphine consumption was 3.03 ± 2.54, 2.7 ± 2.8, and 5.56 ± 3.12 mg for each group, respectively (P < 0.05). As a side effect, bleeding was observed in groups 1 and 3, nausea and vomiting in all groups, and edema only in group 3. However, no significant differences were detected in any of the parameters analyzed, which also included epigastric pain, constipation/diarrhea and headache. Similar hematological test results were obtained for all groups. Preemptive administration of piroxicam-β-cyclodextrin effectively reduced analgesic consumption, and 40 mg of the drug was more effective than 20 mg piroxicam-β-cyclodextrin without side effects during the postoperative period.
Evaluation of the effects of different anesthetic techniques on neonatal bilirubin levels
(Aras Part Medical International Press, 2014) Eskicioğlu F.; Ozlem S.; Bilgili G.; Baytur Y.
Objectives: The aim of the present study was to determine whether different anesthetic techniques applied for vaginal delivery and cesarean section affect neonatal bilirubin levels in the first 24 hours of life.; Materials and Methods: A total of 511 neonates delivered by vaginal route or cesarean section were included in the study. The neonates were classified according to method of delivery and anesthetic agents as group A (cesarean section/general anesthesia with sevoflurane), group B (cesarean section/ spinal anesthesia with bupivacaine hydrochloride), group C (vaginal delivery with episiotomy/local anesthesia with prilocaine hydrochloride) and group D (vaginal delivery/ no anesthesia). The levels of neonatal serum bilirubin in the groups were compared.; Results: There was no difference between group A and group B in terms of neonatal bilirubin levels (p = 0.98). Depending on the use of prilocaine hydrochloride as local anesthetic agent in the vaginal delivery, there was no significant difference between the groups C and D, in terms of the neonatal bilirubin levels (p = 0.99). The serum levels of bilirubin in cesarean section groups were significantly higher than those of the vaginal delivery groups (p<0.001).; Conclusion: Prilocaine hydrochloride used for episiotomy did not exert any effects on neonatal hyperbilirubinemia. However, cesarean section with sevoflurane and bupivacaine hydrochloride seemed to result in increased bilirubin levels. © 2014 / PMCARAS . All rights reserved.

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