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Öğe Acute respiratory İnsufficiency due to peripartum cardiomyopathy after caesarean section in a term pregnancy with twins(2010) Demiraran, Yavuz; İskender, Abdülkadir; Ersoy, Özlem; Albayrak, Mustafa; Kaynak, Gürselİkiz gebeliği olan ve postoperatif dönemde kardiyomiyopatiye bağlı akut solunum yetmezliği gelişen bir olgu sunulmuştur. Bizim olgumuzda, 30 yaşında 32 haftalık ikiz gebeliği olan kadın hasta preterm membran rüptürü nedeniyle Kadın Hastalıkları ve Doğum kliniğine yatırıldı. Tokolizden 48 saat sonra genel anestezi altında hasta operasyona alındı. Uyandırma döneminde SpO2 %32 saptanan hastada taşikardi ve takipne gelişti. Oskültasyonda her iki akciğer alt zonda krepitan raller tespit edildi. Hasta pozitif basınçlı ventilasyona rağmen oksijen satürasyon yüzdesinin düşük seyretmesi ve siyanozunun devam etmesi nedeniyle, Yoğun Bakım Ünitesi’ne entübe halde alındı. Çekilen akciğer grafisinde, her iki akciğer alt loblarında pulmoner infiltratlar ve kalp gölgesinin genişlemiş olduğu tespit edildi. Ekokardiyografik incelemesinde ejeksiyon fraksiyonu %45, sol ventrikül sistolik disfonksiyonu, sol ventrikül boyutlarında artma, orta mitral kapak yetmezliği ve hafif triküspit kapak yetmezliği saptanan hastada, bu tabloyu açıklayacak anemi dışında bulgu saptanmadı. Peripartum kalp yetmezliği tanısı konan hastaya lisinopril ve furosemid başlandı. Postoperatif 4. günde hasta mekanik ventilatörden ayrıldı, postoperatif 7. günde taburcu edildi.Öğe Adding intrathecal morphine to unilateral spinal anesthesia results in better pain relief following knee arthroscopy(Springer Tokyo, 2008) Demiraran, Yavuz; Yücel, İstemi; Akçalı, Gülgün Elif; Değirmenci, Erdem; Sezen, Gülbin; İskender, AbdülkadirIntrathecal morphine is administered to provide profound and prolonged analgesia, and to treat acute postoperative pain. We compared the effectiveness of hyperbaric bupivacaine alone and in combination with morphine for unilateral spinal anesthesia in patients undergoing knee arthroscopy. Sixty patients were randomly allocated to two groups to receive either 1.2 ml (6 mg) of 0.5% hyperbaric bupivacaine (group B; n = 30) or 1.2 ml of 0.5% hyperbaric bupivacaine containing 0.16 mg of morphine (group BM; n = 30). Spinal block was assessed by pinprick and a modified Bromage scale and compared between the operated and nonoperated sides. Visual analog scale (VAS) values, duration of analgesia, and total analgesic requirement of patients were recorded. Patients in group BM had significantly lower VAS values on movement at 30 min and at 2, 4, 6, and 12 h postoperatively (P < 0.05 and P < 0.001, P < 0.001, P < 0.001, and P < 0.05, respectively). The total analgesic requirement in the first 24 h after surgery was significantly higher in group B (P < 0.001). Patients in group BM had a significantly longer duration of analgesia in the first 24 h postoperatively (P < 0.001). Motor blockade of the operated limb in group BM was similar to that in group B (P > 0.05), and motor blockade of the nonoperated limb in group BM was also similar to that in group B (P > 0.05). We conclude that unilateral spinal anesthesia with hyperbaric bupivacaine plus 0.16 mg morphine is preferable to hyperbaric bupivacaine alone with respect to analgesic requirement, duration of analgesia, and VAS values.Öğe The assessment of bupivacaine-tramadol and levobupivacaine-tramadol combinations for preemptive caudal anaesthesia in children: a randomized, double-blind, prospective study(E-Century Publishing Corp, 2014) Sezen, Gülbin; Demiraran, Yavuz; Karagöz, İbrahim; Küçük, AdemCaudal block is the regional anesthetic technique that is used most frequently in pediatric surgery and bupivacaine and levobupivacaine are widely utilized in this technique. Opioid drugs have been added to local anesthetic solutions to prolong duration of analgesia but ideal combination were not found. We compared the postoperative analgesic efficacy of equal concentrations of bupivacaine or levobupivacaine plus tramadol in pediatric patients. Sixty eight children aged 2 to 7 years who were undergoing inguinal herniorrhaphies or orchidopexies received bupivacaine 0.25% plus tramadol 2 mg/kg (1 ml/kg) (BT group) or levobupivacaine 0.25% plus tramadol 2 mg/kg (1 ml/kg) (LT group) by the caudal route after laryngeal mask anesthesia. The primary outcome of the study was to compare the duration and quality of postoperative analgesia. The postoperative pain relief was evaluated by the Children and Infants Postoperative Pain Scale (CHIPPS) at 2, 4, 6, 12, and 24 h postoperatively. In addition, the time of first analgesic requirement was noted. The CHIPPS scores were not statistically different between the groups. The duration of analgesia and requirements for rescue analgesia was similar. Urinary retention was observed more often in the BT group. There were no significant differences between groups for arterial pressures and heart rate values after caudal block and during the operation. Caudal bupivacaine plus tramadol and levobupivacaine plus tramadol have similar postoperative analgesic efficacy. But the use of bupivacaine plus tramadol may cause a greater frequency of urinary retention.Öğe Atypical preeclampsia and eclampsia: Report of four cases and review of the literature(2010) Albayrak, Mustafa; Özdemir, İsmail; Demiraran, Yavuz; Dikici, SüberKlinik olarak preeklampsi (hipertansiyon ve proteinüri) geliştiren çoğu kadında bulgular 20 gebelik haftasından postpartum 48 saate kadar ortaya çıkar ve bu özellikle diğer yönlerden sağlıklı nullipar gebelerde böyledir. Son bazı çalışmalarda preeklampsi ve hatta eklampsinin hipertansiyon ve proteinüri olmadan gelişebileceği gösterilmiştir. Burda biz dört atipik vaka takdim ettik: proteinüri ve hipertansiyon olmadan eklampsi (olgu 1), hipertansiyon olmaksızın proteinüriyi takip eden parsiyel eklampsi nöbeti (olgu 2), fetal distresle gelen ancak hipertansiyon olmayan bir vaka (olgu 3) ve hızlı gelişen tedaviye yanıt vermeyen masif proteinüri vakası (olgu 4). Atipik eklampsideki problem tahmin edilemeyen ortaya çıkışıdır, o nedenle zamanında tanı ve müdahale komplikasyonları engellemek için elzemdir. Bu yazının amacı gebelikteki atipik hipertansif durumlar hakkındaki bilinci arttırmaktır.Öğe Atypical preeclampsia and eclampsia: Report of four cases and review of the literature(2010) Albayrak, Mustafa; Özdemir, İsmail; Demiraran, Yavuz; Dikici, SüberClassically,most women who develop preeclampsia (hypertension and proteinuria) present some time after 20 weeks of gestation up to 48 h postpartum;and this is especially true in otherwise healthy,nulliparous pregnancies.Recent data suggest that in some women,preeclampsia and even eclampsia may develop in the absence of hypertension or proteinuria.Here,we report four atypical cases:Eclampsia in the absence of hypertension and proteinuria(case1),a partial seizure following eclampsia with antecedent proteinuria, but no hypertension(case2),a case presenting with fetal distress,but no hypertension(case3),and a case with unusually rapid progression and massive proteinuria that was unresponsive to therapy(case4).Problems with atypical forms of eclampsia lie in its unpredictable onset;Timely diagnosis and management are critical in avoiding complications.The purpose of this review is to increase he awareness of atypical forms of hypertensive disorders during pregnancy.Öğe B-Lynch suture after the failure of hypogastric artery ligation to control post-partum hemorrhage due to placenta increta in a patient with the factor V Leiden mutation(Blackwell Publishing, 2007) Somunkıran, Aslı; Özdemir, İsmail; Demiraran, Yavuz; Yücel, OğuzPost-partum hemorrhage may be a life-threatening condition. A case of a patient receiving antithrombotic therapy for the factor V Leiden mutation, in whom post-partum hemorrhage had occurred due to placenta increta, is described. In this case, the post-partum hemorrhage did not respond to bilateral hypogastric artery ligation, while the B-Lynch surgical technique was successful in obtaining hemostasis.Öğe Batı Karadeniz Bölgesindeki akut pankreatitli hastaların retrospektif analizi(2010) Yaşar, Mehmet; Taşkın, Ali Kemal; Özaydın, İsmet; Demiraran, YavuzGiriş: Bu çalışma ile kliniğimizde akut pankreatit tanısıyla takip edilen hastaların etiyoloji, tanı ve tedavi yöntemleri, morbidite, mortalite ve Ranson kriterlerinin prognoza etkisi retrospektif olarak analiz edildi. Gereç ve Yöntem: Düzce Üniversitesi Genel Cerrahi Anabilim Dalı’nda 2003–2008 yıllarında 44’ ü (%70.9) ) hafif, 18’ i (%29.1) şiddetli toplam 62 Akut Pankreatit (AP) vakası retrospektif olarak analiz edilmiştir. Bulgular: Akut pankreatitin etiyolojik nedenlerden safra taşı 40 (%64,5), idiyopatik 11 ( % 17.7), hiperlipidemi 4 (% 6.4), alkol-hiperlipidemi 3 (%4.8), alkol 2 (%3,2), ERCP sonrası 2 (%3.2) idi. Akut pankreatit tanısıyla takip edilen hastaların ortalama yaşı 59.6 (18 – 84) olup, 23 (%37)'si erkek, 39 (% 63) 'sı da kadın idi. Biliyer pankreatitli 40 hastanın 14'üne Endoskopik Retrograd Kolanjiopankreatografi (ERCP) uygulandı. Biliyer pankreatitli hastaların, 2 sine de persistan biliyer pankreatit nedeniyle, 6 sına da kolesistit eşlik ettiği için ilk 48 saat içinde, 23 hastaya da akut atak sonrası kolesistektomi uygulanmıştır. Bilier pankreatitli İlk 6 vakanın 3’ üne laporoskopik kolesistektomi yapılırken açığa geçildi. Lokal anestezi altında 2 hastaya peritoneal lavaj, 4’üne tanısal diyagnostik laparoskopi, 2 ‘sine de nekroz eksizyonu yapıldı. Ortalama hastanede kalış süresi hafif olgular için 9.8, ağır olgular için 11.2 gündü. Şiddetli gruptan etiyolojisi idiyopatik olan 3 ( % 4,8) hasta exitus olmuştur. Sonuç: Akut pankreatit mortalitesi yüksek seyredebilen bir hastalıktır. Akut pankreatit etiyolojisinde en sık biliyer nedenler rol oynamaktadır. İdiyopatik AP ikinci sıklıkta rol oynadığı, alkol oranının oldukça düşük olduğu izlenmiştir. Biliyer pankreatitli olguların tedavisinde ilk aşamada ERCP faydalı bir yöntemdir. Mortalitenin genelde Şiddetli AP’ li hastalarda gözlendiği gibi tanı,tedavi ve takip bu hastalarda önem arz etmiştir.Öğe Bilateral alt ekstremite uzuv kaybı olan geriatrik hastada spinal anestezi: 2 olgu sunumu(2013) Erbaş, Mesut; Öztürk, Ömür; Kiraz, Hasan Ali; Toman, Hüseyin; Şahin, Hasan; Demiraran, YavuzYaşam kalitesinin yükselmesi, yeni teşhis ve tedavi olanaklarının geliştirilmesi ile yaşlı popülasyon tüm dünyada hızla artmaktadır. Yaşlı hasta grubundaki yandaş hastalıklar ve gelişebilecek komplikasyonlar nedeniyle rejyonel anestezi teknikleri genel anesteziye tercih edilmektedir. Spinal anestezinin operasyon sırasında kognitif fonksiyonların ve hava yolu reflekslerinin korunması, postoperatif dönemde etkin analjezinin sağlanması ile birlikte erken mobilizasyon gibi avantajları vardır. Spinal anestezide lokal anesteziğin sefale doğru yayılması ile birlikte preganglionik sempatik liflerde blokaj olması, kardiovasküler yan etkilere yol açabilir. Özellikle geriatrik hastalarda bu hemodinamik instabiliteden kaçınmak için lokal anesteziğin mümkün olan en düşük dozda kullanılması tercih edilmelidir. Biz bu yazıda geriatrik, bilateral alt ekstermite uzuv kaybı olan ve ürolojik girişim geçirecek olan yüksek riskli iki olgumuzda spinal anestezi uygulamamızı ve bilateral uzuv kaybının uyguladığımız lokal anestezik d ozuna etkisini literatür eşliğinde tartışmayı amaçladık.Öğe Can anti-adhesive efficacy of sodium hyaluronate and carboxymethylcellulose membrane be improved further by colchicine and collagenase?(Duzce University Medical School, 2011) Sarohan, Aziz Rodan; Albayrak, Mustafa; Somunkıran, Aslı; Özdemir, İsmail; İskender, Abdülkadir; Sezen, Gülbin Yalçın; Demiraran, YavuzAim: The aim of this study was to determine the impact of collagenase and colchicine in the prevention of postsurgical adhesion formation in a rat uterine horn model. Materials and Methods: Forty female Wistar albino rats were divided into four equal groups including controls, seprafilm, colchicine-seprafilm and collagenase-seprafilm groups. After laparotomy, a standard 0.5-cm injury was made to the antimesosalpingeal side of the right proximal uterine horn by unipolar cautery. After hemostasis, 0.5 cm seprafilm or colchicine 2 mg-0.5 cm seprafilm or collagenase 1?g - 0.5 cm seprafilm was applied to the site of injury. The abdominal incision was then sutured en bloc and the rats were observed for 20 days. Then, all rats were sacrified and second look laparotomy was performed. Macroscopic adhesion score of each rat was noted and histopathologic scoring was made according to Kanbour-Shakir criteria. Results: All of the five scores of the histologic parameters were lowest in the colchicineseprafilm group. The total histologic score of colchicine-seprafilm group was significantly lower than controls, seprafilm and collagenase-seprafilm groups (p<0.05). Conclusions: The results of this rat model suggested that local use of colchicines in the abdominal operations prevents formation of postsurgical adhesions based on both visual assessment and histological analyses. The promising result obtained from this experimental study needs further investigation. © 2011 Düzce Medical Journal.Öğe Can anti–adhesive efficacy of sodium hyaluronate and carboxymethylcellulose membrane be improved further by colchicine and collagenase?(2011) Sarohan, Aziz Rodan; Albayrak, Mustafa; Somunkıran, Aslı; Özdemir, İsmail; İskender, Abdülkadir; Sezen, Gülbin Yalçın; Demiraran, YavuzAmaç: Cerrahi sonrası intraperitoneal adezyonların oluşumunu önlemede kollajenaz ve kolşisinin etkinliklerini deneysel hayvan modelinde histopatolojik değerlendirme ile araştırmaktır. Gereç ve Yöntem: Çalışmada 40 adet dişi Wistar Albino cinsi rat kullanıldı. Ratlar, kontrol, seprafilm, kolşisin-seprafilm, kollajenaz-seprafilm olmak üzere dört gruba ayrıldı. Laparotomi ile sağ proksimal uterin horn antimezosalpingeal yüzde bisturi aracılığı ile 0.5 cm’lik bir kesi oluşturuldu. Takiben kesi üstüne deneklerin grubuna uygun olarak 0.5 cm’lik Seprafilm; 2 mg Kolşisin emdirilmiş 0.5 cm’lik Seprafilm; 1?g kollajenaz emdirilmiş 0.5 cm’lik Seprafilm yerleştirilerek batın kapatıldı. Kontrol grubuna herhangi bir ajan uygulanmadı. Ratlar 20 gün sonra sakrifiye edilerek makroskopik ve histopatolojik değerlendirmeleri yapıldı. Histopatolojik inceleme Kanbour-Shakir kriterlerine göre yapıldı. Bulgular: Histopatolojik olarak değerlendirilen beş parametrenin toplamı ile elde edilen histolojik toplam skorun kolşisin-seprafilm grubunda en düşük olduğu görüldü. Kolşisinseprafilm grubunun total histolojik skoru ile kontrol, seprafilm ve kollajenaz-seprafilm gruplarının ortalama histolojik skorları arasında istatistiksel olarak anlamlı ölçüde farklılık bulundu (p0.05). Sonuç: Batın içi operasyonlarda kolşisinin uzun süre lokal olarak etki etmesini sağlayacak bir metod ile kullanımı, cerrahi sonrası adezyon oluşumunu hem makroskopik hem de histolojik olarak azaltmaktadır. Bu deneysel çalışmadan elde edilen umut verici sonuçların araştırılacağı daha geniş kapsamlı çalışmalara ihtiyaç vardır.Öğe Comparison of costs and efficacy of intravenous and orally disintegrating ondansetron tablet as a prophylactic antiemetic therapy in major gynecologic operations(2005) Demiraran, Yavuz; Özdemir, İsmail; Akbay, Buket Kocaman; Hayıt, Feray; Demirci, FuatObjective: The aim of the study is to compare the antiemetic efficacy and costs of oral rapid disintegrating ondansetron tablets and intravenously administered ondansetron in patients undergoing major gynecologic surgery. Materials and Methods: Anesthesia was induced with thiopenthone, vecuronium and fentanyl. Nitrous oxide and sevoflurane were used to maintain anesthesia. Patients were prospectively randomized into three groups of 30 patients each, receiving either ondansetron 8 mg intravenously or saline infusion only or oral rapid disintegrating tablets of 8 mg ondansetron. The patients were evaluated for nausea and vomiting at 1st, 5th, 10th, 20th, 30th, 60th, and 120th minutes and 6th hours postoperatively. Results: There were no significant differences in adverse effects between placebo group, intravenous ondansetron group and oral ondansetron group (P>0.05). The incidence rates of nausea, vomiting and the need of metoclopropamide were higher in placebo group than intravenous and oral ondansetron groups (P<0.05). Conclusion: Postoperative nausea and vomiting are common during recovery from general anesthesia. Both oral and intravenous forms of ondansetron are efficacious in the prevention of this postoperative nausea and vomiting. Orally disintegrating tablets are inexpensive and may be administered more easily than the intravenous form of ondansetron. Therefore, oral ondansetron tablet may be an alternative to intravenous ondansetron infusion for postoperative nausea and vomiting after major gynecologic operations.Öğe Comparison of effects on the oxidant/antioxidant system of sevoflurane, desflurane and propofol infusion during general anesthesia(Elsevier Science Inc, 2015) Erbaş, Mesut; Demiraran, Yavuz; Yıldırım, Hayriye Ak; Sezen, Gülbin; İskender, Abdülkadir; Karagöz, İbrahim; Kandiş, HayatiBackground and objectives: Desflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy. Methods: 45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P n: 15), sevoflurane (group S n: 15) and desfiurane (group D n: 15). All groups were given hypnotic 2 mg/kg propofol IV, 1 mcg/kg fentanyl IV and 0.1 mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12 mg/kg/h for the first 10 min, 9 rrig/kg/h for the second 10 min and 6 mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants. Results and conclusions: The 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desfiurane increased the total oxidants level by a significant amount compared to levels before the operation. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe Comparison of High-Dose Extracorporeal Shockwave Therapy and Intralesional Corticosteroid Injection in the Treatment of Plantar Fasciitis(Amer Podiatric Med Assoc, 2010) Yücel, İstemi; Özturan, Kutay Engin; Demiraran, Yavuz; Değirmenci, Erdem; Kaynak, GürselBackground: The aim of this study was to evaluate the results of high-dose extracorporeal shockwave therapy applied with an ankle block and corticosteroid injection in patients with plantar fasciitis whose symptoms persisted for more than 6 months. Methods: Sixty patients were assessed clinically at presentation and at 3-month follow-up with a patient-assessed 100-mm visual analog scale of pain and a physician-assessed heel tenderness index. A therapeutic response rate was evaluated. A decrease of at least 50% from baseline to 3 months in visual analog scale or heel tenderness index scores was accepted as a successful result. Results: Extracorporeal shockwave therapy and corticosteroid injection provided significant improvements in visual analog scale and heel tenderness index scores, but between the two groups there was no significant difference in the visual analog scale score change 3 months after treatment (P > .05). Twenty-seven of 33 patients (82%) in the extracorporeal shockwave therapy group and 23 of 27 (85%) in the corticosteroid injection group had a successful therapeutic response after 3 months. Conclusions: Corticosteroid injection and extracorporeal shockwave therapy are successful treatment modalities for plantar fasciitis. Corticosteroid injection treatment is cost effective compared with extracorporeal shockwave therapy, and corticosteroid injection may be the first treatment choice according to these results. (J Am Podiatr Med Assoc 100(2): 105-110, 2010)Öğe A comparison of intrathecal sufentanil combined with either hyperbaric bupivacaine or hyperbaric ropivacaine for cesarean deliveries(2006) Hayit, F.; Demiraran, Yavuz; Sezen, Gülbin; Akbay, Buket Kocaman; İskender, Abdülkadir; Özdemir, I.Objective: In this study, we aimed to compare the motor and sensorial block characteristics, maternal and fetal effects, of intrathecal sufentanil combinations including either hyperbaric bupivacaine or hyperbaric ropivacaine in pregnant women undergoing spinal block for elective cesarean deliveries. Method: Sixty pregnant women between 18 and 40 years undergoing elective cesarean section were studied in a randomized prospective design. In group HBS, 12.5 mg hyperbaric bupivacaine and 5 ?g sufentanil in 3 mL serum physiologic was applied intrathecally in 30 of the women. In group HRS, 12.5 mg hyperbaric ropivacaine and 5 ?g sufentanil in 3 mL serum physiologic was applied intrathecally to the other 30. Results: In group HRS, the duration for reaching the maximum sensorial block was shorter in comparison to group HBS, although the difference was not statistically significant. The two-segment regression time was shorter in group HRS, when compared to group HBS. Motor block development time and motor block recovery time were statistically shorter in group HRS (p<0.05). Conclusion: Sufentanil combinations with either intrathecal hyperbaric bupivacaine or intrathecal hyperbaric ropivacaine can be used safely on patients undergoing cesarean deliveries.Öğe Comparison of sevoflurane and halothane on induction and recovery in pediatric patients(2004) Şerifsoy, Talat Ercan; Demiraran, Yavuz; Çelikel, N.; Akbay, Buket KocamanIn this study, the effects of sevoflurane and halothane on induction and emergence and were compared. The study enrolled 60 ASA I-II pediatric patients aged between 0-12 years. They received no premedication and were randomized into two groups, one of which received sevoflurane anesthesia (S) and the other halothane anesthesia (H). Each of these volatile anesthetics were adminisrated in 33% oxygen and 67% nitrous-oxide mixture, in increasing doses. When the eye-lash reflex disappeared, the volatile anesthetic concentration was kept constant for four and a half minutes to complete the induction of anesthesia, until the patients were intubated. Following intubation, the volatile anesthetic dose was reduced to 1-1.5 MAC for maintenance. At the end of the surgical procedure, all volatile anesthetics were stopped and 100% oxygen was administrated. During induction, the time between the beginning of the administration of the volatile anesthetic to the patient and the loss of the eye-lash reflex was recorded. During recovery, the time between the beginning of application of 100% oxygen and the first swallowing reflex, the first leg-pulling, the extubation time and the time of crying were noted. There were statistically significant difference the first leg-pulling times between the two groups. Laryngospasm was observed in two patients in Group H, vomiting was observed in one patient in Group H and 3 patients in Group S. The utilisation of sevoflurane in the pediatric patiens may be safer than halothane in terms of having shorter recovery time and no laryngospasm during the induction.Öğe Comparison of the effects of %0.5 bupivacaine and %0.5 levobupivacaine used for epidural anesthesia on QT dispersion and haemodynamy(2010) Özdemir, Yaşar; Sezen, Gülbin Yalçın; Demiraran, Yavuz; Yazıcı, Mehmet; İskender, Abdulkadir; Yücel, İstemiObjective: The aim of this study was to compare the hemodynamic variables and QT dispersion effects of 05% bupivacaine and 0.5% levobupivacaine using epidural via. Methods: Sixty patients scheduled for operation under epidural anesthesia were included to this study. The patients were randomized into two groups; 15 mL of 0.5% bupivacaine was given to Group B patients (n=30) and 15 mL of 0.5% levobupivacaine was given to Group L patients (n=30). Systolic blood pressure, diastolic blood pressure, mean blood pressure, heart rate, saturation of peripheral oxygen, respiratory rate and side-effects were recorded during perioperative period. Postoperatively, motor blockade recovery time was assessed at 30-minute inten'als and total motor blockade time was recorded. ECG was recorded at preoperatively, at 30 minutes after first epidural anesthetic and postoperatively 24-hour and was assessed by a cardiologist. Results: Motor blockade and total blockage time were found to be longer in Group B (p<0.05). Mean blood pressure at the 180th minute was found to be decreased in Group B (p<0.05). The longest corrected QT interval and the shortest corrected QT interval were increased in Group B (p<0.05). Incidence of hypotension was higher in Group B (p<0.05). Conclusion: Levobupivacaine can be preferred to bupivacaine in patients having cardiac problem and when less motor blockade is desired.Öğe Complex regional pain syndrome type I: Efficacy of stellate ganglion blockade(2009) Yücel, İstemi; Demiraran, Yavuz; Özturan, Kutay; Değirmenci, ErdemBackground: This study was performed to evaluate the treatment of complex regional pain syndrome (CRPS) type I with stellate ganglion blockade. Materials and methods: We performed three blockades at weekly intervals in 22 patients with CRPS type I in one hand. The patients were divided into two groups depending on the time between symptom onset and treatment initiation. Group 1and 2 patients had short and long symptom-onset-to-treatment intervals, respectively. Pain intensity, using a visual analog score (VAS), and range of motion (ROM) for the wrist joint were assessed before and 2 weeks after treatment and were compared using nonparametric statistical analysis. Results: Treatment produced a statistically significant difference in wrist ROM for all patients (P < 0.001). VAS values showed an overall decrease from 8 ± 1 to 1 ± 1 following treatment, and there was a significant difference in VAS value between groups 1 and 2 (P < 0.05). Conclusions: We concluded that stellate ganglion blockade successfully decreased VAS and increased ROM of wrist joints in patients with CRPS type I. Further, the duration between symptom onset and therapy initiation was a major factor affecting blockade success. © 2009 Springer-Verlag.Öğe Deliberate Posterior Low Transverse Incision at Cesarean Section of a Gravid Uterus in 180 degrees of Torsion A Case Report(Sci Printers & Publ Inc, 2011) Albayrak, Mustafa; Benian, Ali; Özdemir, İsmail; Demiraran, Yavuz; Güralp, OnurBACKGROUND: Torsion of the term gravid uterus is a rare, potentially serious, unexpected obstetric pathology and is almost always diagnosed at cesarean section. We report a case of deliberate posterior low transverse segment hysterotomy in irreducible uterine torsion at 41 weeks' gestation. CASE: A 29-year-old nullipara with a 15-cm uterine fibroid was admitted at 41 weeks' gestation with regular uterine contractions. Cesarean delivery was carried out for obstructed labor. Intraoperatively, 180 degrees levotorsion of the uterus was diagnosed. Following unsuccessful attempts at detorsioning the uterus, a posterior low transverse hysterotomy was performed for delivery. CONCLUSION: Delivery by a posterior low transverse hysterotomy may be feasible in uterine torsion after unsuccessful attempts at detorsioning the uterus during cesarean section at term. (J Reprod Med 2011;56:181-183)Öğe Deliberate posterior low transverse incision at cesarean section of a gravid uterus in 180° of torsion: A case report(2011) Albayrak, M.; Benian, Ali; Özdemir, İsmail; Demiraran, Yavuz; Güralp, OnurBackground: Torsion of the term gravid uterus is a rare, potentially serious, unexpected obstetric pathology and is almost always diagnosed at cesarean section. We report a case of deliberate posterior low transverse segment hysterotomy in irreducible uterine torsion at 41 weeks' gestation. Case: A 29-year-old nullipara with a 15-cm uterine fibroid was admitted at 41 weeks' gestation with regular uterine contractions. Cesarean delivery was carried out for obstructed labor. Intraoperatively, 180° levotorsion of the uterus was diagnosed. Following unsuccessful attempts at detorsioning the uterus, a posterior low transverse hysterotomy was performed for delivery. Conclusion: Delivery by a posterior low transverse hysterotomy may be feasible in uterine torsion after unsuccessful attempts at detorsioning the uterus during cesarean section at term. © Journal of Reproductive Medicine®, Inc.Öğe Does postoperative misoprostol use induce intestinal motility? A prospective randomised double-blind trial(Wiley, 2007) Demirci, Fuat; Somunkıran, Aslı; Gul, Özlem Kemik; Demiraran, Yavuz; Özdemir, İsmail; Gül, Özgür BarışBackground: Misoprostol has been shown to increase colonic activity and decrease colonic transit time in chronic constipation patients. Aims: The aim of this prospective, randomised, double-blind study was to examine the effectiveness of rectally administered misoprostol on inducing intestinal motility after gynaecological surgery. Methods: Eighty women who underwent hysterectomy were divided randomly into three groups. Group A received misoprostol 200 mu g rectally while group B received 400 mu g rectal misoprostol after surgery before leaving the operating room. Patients in group C received no drugs. Bowel sounds in four quadrants were checked every hour and possible side-effects of misoprostol like nausea, vomiting, and distension were evaluated. The time interval between surgery and flatus pass and the need of analgesics were noted. Statistical analyses were done with Mann-Whitney U-test and chi(2) tests where available. Results: The time between surgery and presence of bowel sounds in four quadrants were similar in all groups (2.7 +/- 1.6, 2.9 +/- 1.2, 2.8 +/- 1.3 h, for groups A, B, and C, respectively). No difference was observed in flatus pass time. The incidence of nausea was significantly increased in group B compared to controls (P < 0.01). Additional analgesic need was significantly higher in groups A and B when compared to controls (P < 0.05 and P < 0.01, for groups A and B, respectively). Conclusion: Rectally administered misoprostol does not improve intestinal motility in the early postoperative period and thus, it is not effective in providing early oral food intake. On the contrary, it causes distention that requires additional analgesics and vomiting that naturally limits oral diet intake.
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