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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 Anophthalmia, cleft lip/palate, absent vomer bone, nystagmus, and mental-motor retardation: A new syndrome or Fryns "anophthalmia-plus" syndrome?(Alliance Communications Group Division Allen Press, 2008) Özçelik, Derya; Sağlam, İbrahim; Sılan, Fatma; Sezen, Gülbin; Ünveren, ToygarObjective: We report that a 4-year-old boy presented with right unilateral complete cleft lip and palate, right anophthalmos, left congenital nystagmus, absence of the vomer bone, mental-motor retardation, and normal lymphocyte karyotype (46, XY). Methods: For reconstruction of the deformities, we performed cleft lip repair by Millard's rotation-advancement technique and planned cleft palate repair. Conclusions: This combination of cleft lip and palate, anophthalmos, congenital nystagmus, absent vomer bone, and mental-motor retardation has not, to our knowledge, previously been described. We suggest that this represents either another case of the rare Fryns "anophthalmia-plus" syndrome or a new syndrome.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 Asystole after the first dose of ceftriaxone(W B Saunders Co-Elsevier Inc, 2012) Sarıtaş, Ayhan; Erbaş, Mesut; Gönen, İbak; Candar, Melik; Öztürk, Ömür; Kandiş, Hayati; Sezen, GülbinThe incidence of ceftriaxone-related hypersensitivity skin reactions is between 1% and 3%, whereas anaphylaxis is rare. To the best of our knowledge, the following case is the first report of asystole after the administration of single-dose ceftriaxone. A 55-year-old man was admitted to our emergency department because of high fever, abdominal pain, dysuria, and weakness. To determine the cause of his fever, blood and urine cultures were obtained. Then, an infusion of 1 g ceftriaxone was started slowly. One minute later, cardiac arrest occurred. The rhythm was asystole. Cardiopulmonary resuscitation and tracheal intubation were performed immediately, and the ceftriaxone infusion was discontinued. Within 20 minutes, circulation was restored. The time of onset was suggestive of ceftriaxone-induced anaphylaxis. The patient was discharged in good clinical condition on the 10th day of admission. Emergency physicians should be mindful of the possibility of anaphylaxis and asystole that could occur with the first dose of ceftriaxone and should also make sure to offer receiving detailed informed patient consent, too.Öğe Atroskopik Girişimlerde VİMA Ve TİVA İndüksiyonu Sonrası LMA Uygulamasının Solunum Fonksiyonlarına Etkisinin Karşılaştırılması(Kocaeli Derince Eğitim ve Araştırma Hastanesi, 2012) Yavuz, Selin; Karagöz, İbrahim; Şeker, İlknur Suidiye; Sezen, GülbinAMAÇ: Çalışmamızda artroskopik girişimlerde bir gruba VİMA (sevofluran ile), diğer gruba TİVA (propofol ile) indüksiyonu sonrası LMA uygulamasının solunum fonksiyonlarına etkisini karşılaştırmayı amaçladık.YÖNTEMLER: Bilgilendirilmiş hasta onamları alındıktan sonra genel anestezi ile operasyonu planlanan ASA 1-2, 18-60 yaş arası, artroskopi operasyonu olacak 50 hasta çalışmaya dahil edildi. Grup 1 sevofluran ile VİMA (n=25), Grup 2 propofol ve remifentanil infüzyonu ile TİVA (n=25) olmak üzere 2 gruba ayrıldı. Çalışmaya dahil edilen tüm hastalara Göğüs Hastalıkları polikliniğinde preoperatif, postoperatif 2.saat ve postoperatif 24.saat solunum fonksiyon testi yapıldı. Test 3 sefer tekrar edilerek en iyi FVC ve FEV1 değerleri seçildi. Operasyon odasına alındıktan sonra elektrokardiyografi, sistolik kan basıncı, diastolik kan basıncı, ortalama kan basıncı, kalp atım hızı, periferik oksijen satürasyonu monitorize edildi.BULGULAR: Postoperatif periyottaki FEV1, FVC, FEF %25-75 değerleri preoperatif ve taburculuktaki duruma göre anlamlı düzeyde düşük çıkmış, ancak preoperatif ve taburculuktaki FEV1, FVC, FEF %25-75 değerleri arasına anlamlı fark bulunmamıştır. Bunların yanı sıra TİVA grubundaki FEV1 ve FVC ortalaması VİMA grubuna göre her üç ölçüm periyodunda da anlamlı düzeyde düşük bulunmuştur. FEV1/FVC bakımından yapılan değerlendirme sonucunda anestezi grupları arasında anlamlı fark bulunmamıştır. Ayrıca preoperatif, postoperatif ve taburculuk öncesi ölçüm periyotları arasında da anlamlı fark bulunmamıştır.SONUÇ: Genel anestezi sonrası her iki grupta da FVC,FEV1, FEF %25-75 gibi solunumsal parametrelerde azalma saptadık. Değişmeyen FEV1/FVC oranıyla beraber akciğer fonksiyonlarında azalma her iki grupta da gözlendi.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 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 Does premedication with dexmedetomidine provide perioperative hemodynamic stability in hypertensive patients?(Biomed Central Ltd, 2014) Sezen, Gülbin; Demiraran, Yavuz; Şeker, İlknur Suidiye; Karagöz, İbrahim; İskender, Abdülkadir; Ankaralı, Handan; Özlü, OnurBackground: Perioperative hemodynamic fluctuations are seen more often in hypertensive patients than in normotensive patients. The purpose of our study was to investigate the perioperative hemodynamic effects of dexmedetomidine and midazolam used for premedication in hypertensive patients relative to each other and in comparison to normotensive patients. Methods: One-hundred-forty female, normotensive or hypertensive patients undergoing myomectomies or hysterectomies. They were randomly enrolled into the subgroups: Group ND (normotensive-dexmedetomidine); Group HD (hypertensive-dexmedetomine); Group NM (normotensive-midazolam); Group HM (hypertensive-midazolam). Dexmedetomidine was administered at a concentration of 0.5 mu g.kg(-1), and midazolam was administered at a concentration of 0.025 mu g.kg(-1) via intravenous (IV) infusion before the induction of anaesthesia. Haemodynamic parameters were recorded at several times (T-beginning, T-preop5 min, T-preop 10 min, T-induction, T-intubation, T-intubation 5 min, T-initial surgery, T-surgery 15 min, T-surgery 30 min, T-extubation, T-extubation 5 min). Propofol amount for induction, time between induction and initial surgery, demand of antihypertensive therapy, rescue atropine were recorded. Quantitative clinical and demographic characteristics were compared using One Way ANOVA. The values were compared using One-way Analysis of Variance. Additionally periodic variations were examined by One way Repeated Measures Analysis of Variance for groups separately. Results: SBP was significantly different between normotensive and hypertensive groups at the following time points: T-preop 5 min, T-preop 10 min, T-induction, T-intubation, T-intubation 5 min and T-initial surgery. MBP was significantly different in the hypertensive groups at T-induction, T-intubation, T-intubation 5 min, T-initial surgery, T-surgery 15 min, T-surgery 30 min, T-extubation and T-extubation 5 min. The perioperative requirements for antihypertensive drugs were significantly higher in Group HM. Conclusion: In the hypertensive patients, dexmedetomidine premedication provides better hemodynamic stability compared with midazolam, and because it decreases the antihypertensive requirements, its use might be beneficial.Öğe Effect of chronic obstructive pulmonary disease on washout time of sevoflurane anesthesia: a placebo controlled randomized trial(E-Century Publishing Corp, 2016) Şeker, İlknur Suidiye; Demiraran, Yavuz; Haftacı, Engin; Cangür, Şengül; Sezen, Gülbin; Özlü, Onur; Karagöz, İbrahimBackground: Respiratory functions and gas exchange deteriorates in patients with COPD. In our study, we aimed to investigate if there is any relationship between the washout time of sevoflurane and chronic obstructive pulmonary disease (COPD). Method: Sixty patients, American Society of Anesthesiology (ASA) 1-3 status; aged between 18-60 years old who underwent general anesthesia for an operation were enrolled in our study. Patients were divided into two groups: Group N (non-COPD n = 33), group COPD (patients with COPD, n = 33). Two patients were excluded from the study, a total of 31 patients in Group COPD. Pre-operative respiratory function tests were performed and standard monitoring was provided in the operation room. Both groups received propofol 2 mg/kg, fentanyl 1.5-2 mcg/kg and rocuronium 0.6 mg/kg intravenously, and an oxygen-air mixture of 50%/50% with a tidal volume of 6 ml/kg (ideal body weight) and sevoflurane of 1 MAC. Remifentanil was administered at 0.05-0.1 mcg/ kg/min intravenously in the maintenance of anesthesia. All patients were monitored by an anesthesia machine until extubation. A sevoflurane vaporizer was closed at the end of the operation and the measurement time was started. FiO2, Fi(ins), Fi(exp) of sevorain, End-tidal CO2 were recorded during the operation and Fins (Sevo)/Fexp (Sevo) ratio, MAC1, MAC2, MAC3, MAC4, extubation times were recorded. Fi(ins)1: percentage of sevorain filiation in inspirium before closing 1 MAC vaporizer. Fi(exp)1: percentage of sevorain filiation in expirium before closing 1 MAC vaporizer. Fi(ins)2: percentage of sevorain filiation in inspirium after closing 0.1 MAC vaporizer. Fi(exp)2: percentage of sevorain filiation in expirium after closing 0.1 MAC vaporizer. Results: There was no significant relationship between the respiratory function tests of individuals with or without COPD and MAC1, MAC2, MAC3, MAC4 and extubation time (P > 0.05). The cut-off criterion for MAC4 was determined to be 210 seconds. Conclusion: Although there was no difference between the washout and extubation times of both groups, increased BMI and decreased intraoperative hemoglobin values should be carefully considered during anesthetic management in the COPD group.Öğe The effect of endotracheal entubation and different laryngeal mask airways on quality of voice(Turkiye Klinikleri, 2014) Kepek, Ökkeş; Sezen, Gülbin; Şeker, İlknur Suidiye; Karagöz, İbrahim; Cangür, ŞengülObjective: Endotracheal intubation (ETI) and laryngeal mask airways (LMA) can cause various laryngeal symptoms and changes in the acoustical characteristics of the voice in the postoperative period. In this study, we aimed to compare the effects of ETI, classical LMA, proseal LMA and I gel LMA on laryngeal symptoms and acoustic analysis parameters of the voice. Material and Methods: Eighty patients who underwent lower abdomen and extremity surgery, which do not effect the formation of the voice, were included in the study. A clinical survey sheet that included questions about hoarseness, globus pharyngeus, need for clearing throat, sore throat, loss of voice, unpleasant voice and cracking voice, was filled by the patients preoperatively, and on postoperative 2nd and 24th hours. All patients had acoustic analyses in an isolated room in the Otorhinolaryngology polyclinic. Acoustic analysis included parameters of basic frequency, jitter (measures of the cycle-to-cycle variations of fundamental frequency), shimmer (measures of the cycle-to-cycle variations of fundamental amplitude), harmonic/noise ratio and normalized noise energy. Results: The increase was statistically significant in group ETI preoperatively and on postoperative 2nd hour when compared to the other groups (p=0.005). In ETI group, hoarseness and need to clearing throat were significantly higher. In classical LMA group, need to clearing throat was significantly higher. No differences were found between T2 and T24 time periods for loss of voice parameters (p=0.179, p=1.000). These clinical evaluations were present in the early postoperative period, and they decreased to normal values on the postoperative 24th hour. In acoustic analysis, only the jitter parameter in the proseal LMA group changed significantly on the 2nd postoperative hour. Other acoustic parameters did not change significantly. Conclusion: We suppose that ETI and classical LMA may have effects on voice functions in the early postoperative period, and newly developed LMAs, especially gel structured laryngeal mask airways, which are not dilated with air, have minimal effects on voice functions and laryngeal complaints. © 2014 by Türkiye Klinikleri.Öğe Effects of different anesthesia protocols on lactation in the postpartum period(AVES Ibrahim Kara, 2014) Kutlucan, Leyla; Şeker, İlknur Suidiye; Demiraran, Yavuz; Ersoy, Özlem; Karagöz, İbrahim; Sezen, Gülbin; Köse, Seyit AliObjective: Many factors can influence the secretion of breast milk. Cesarean section is a risk factor for late onset of breastfeeding.Material and Methods: In our study, we compared the lactation process by mothers who underwent elective cesarean section under general anesthesia, spinal anesthesia, epidural anesthesia, and normal birth; 84 patients between 18-40 years of age with a risk of ASA I-II were included. Randomly patients were divided into four groups: group G (general anesthesia, n:21), group S (spinal anesthesia, n:21), group E (epidural anesthesia, n:21), and group V (vaginal birth, without anesthesia, n:21). Oxytocin and prolactin values of all patients before and after operation or birth were recorded. In addition the initiation time of lactation after delivery or cesarean section were recorded.Results: In all groups, there were no significant differences among hormone levels in the prepartum period (p=0.350). Prolactin levels in group G (p=0.011) and oxytocin levels in group V (p=0.012) in the postpartum period were significantly higher than in the other groups. The start of lactation was significantly delayed in group G (p=0.003).Conclusion: We consider that the onset time of lactation is delayed in patients undergoing cesarean section with general anesthesia when compared with patients who undergo cesarean section with spinal and epidural anesthesia and with patients who undergo normal vaginal birth. Because of the delay of awakening and recovery of cognitive functions in general anesthesia, communication between the mother and the newborn is delayed and so is the lactation. © 2014 by the Turkish-German Gynecological Education and Research Foundation.Öğe Evaluation of Outcomes in Patients Given Dexmedetomidine in Functional Endoscopic Sinus Surgery(Annals Publ Co, 2011) Güven, Damla Güçlü; Demiraran, Yavuz; Sezen, Gülbin; Kepek, Ökkeş; İskender, AbdülkadirObjectives: We aimed to evaluate the effects of dexmedetomidine hydrochloride (DEX) on hemodynamic parameters and on surgeon and patient satisfaction during functional endoscopic sinus surgery (FESS). Methods: Forty patients who were to undergo FESS were enrolled in this randomized, prospective, controlled study. In the DEX group, conscious sedation was induced with an infusion of 1 mu g/kg of DEX 10 minutes before surgery, followed by an infusion of DEX at 0.2 mu g/kg per hour. A control group was given identical amounts of saline solution. During the procedure, hemodynamic data were recorded. The patients evaluated their pain on a visual analog scale (VAS). Intraoperative bleeding was rated on a 6-point scale for evaluation of operative field visibility. Results: We observed that the DEX group had lower bleeding scores (p = 0.019). The heart rates were lower in the DEX group at the time of induction (p = 0.052) and in the 1st (p = 0.009) and 20th minutes (p = 0.039) of induction. The mean blood pressure values were lower in the DEX group in the 5th (p < 0.001), 45th (p = 0.003), and 60th (p = 0.05) minutes of induction. The VAS score was lower in the DEX group in the 30th postoperative minute (p = 0.001); however, the VAS score was lower in the control group after the 12th hour (p < 0.001). Postoperative side effects such as nausea, tachycardia, hypotension, and vomiting were significantly less frequent in the DEX group (p < 0.001). Conclusions: We observed that the intraoperative bleeding, hemodynamic stability, and VAS scores were better and the side effects were less frequent in the DEX group.Öğe An evaluation of the effect of dexmedetomidine on the haemodynamic response, quality of laryngoscopy and endotracheal intubation(2007) Demiraran, Yavuz; Sezen, Gülbin; Özer, Elif; Kocaman, Buket; İskender, AbdülkadirObjective: The aim of our study to evaluate effect of dexmedetomidine, which is used for premedication, on the quality of intubation and hemodynamic effects and to assess its effects on muscle relaxation by using neuromuscular monitorization. Method: A total of 48 patients between the ages of 18 and 55 were enrolled in the study. In Group D, 0.7 mcg kg-1 dexmedetomidine were given via infusion in 10 minutes, Group K was given a saline infusion. Neuromuscular monitorization was performed and the values were recorded before and after the induction. The quality of intubation was evaluated on the triple scale by an anesthesiologist. At the same time, heart rate and mean blood pressure values were recorded. Results: The mean blood pressure values were significantly lower in group K than in group D after the induction and muscle relaxant (p<0.05). When compared with group K, heart rate values in group D were found to be significantly lower during premedication, after induction, muscle relaxant and intubations. Compared with evaluation parameters, intubation quality and muscle relaxation were not significantly different. Conclusion: It was determined that there were no positive effects of dexmedetomidine HCl on the quality of intubation and muscle relaxation and an inhibition of the hemodynamic response was revealed after the intubation.Öğe Evaluation of the effects of desflurane and sevoflurane anesthesia on alveolar epithelial permeability by Tc-99m DTPA inhalation scintigraphy(Tubitak Scientific & Technical Research Council Turkey, 2013) İskender, Abdülkadir; Erkan, Melih Engin; Erbaş, Mesut; Güven, Damla Güçlü; Sezen, Gülbin; Aşık, Muhammet; Yıldırım, MustafaAim: Recently studies showed that volatile anesthetics affect the ciliary beat frequency in vitro. We know that impairment of ciliary beat frequency is related to a risk of pulmonary complications with general anesthesia. Other studies have also shown that exposure to a volatile anesthetic can increase the permeability of the alveolar-capillary barrier. The present study aimed to determine the effects of desflurane and sevoflurane anesthesia on the technetium-labeled diethylene triamine penta-acetic acid (Tc-99m DTPA) clearance rate of the alveolar epithelium. Materials and methods: A total of 40 patients who underwent elective tympanoplasty with general anesthesia were included in this study. Patients having any systemic disease or infection, or with any property that affected lung functions, were excluded from the study. Patients were randomized into 2 groups (20 patients in each) as receiving sevoflurane and desflurane. A Tc-99m DTPA aerosol inhalation lung imaging method was used to assess lung functions. Results: Demographic properties were similar in both groups. There were no significant differences between basal and postoperative lung clearance of inhaled Tc-99m DTPA in either group. Conclusion: We propose that neither sevoflurane nor desflurane induces pulmonary alveolar capillary injury in the acute period of general anesthesia based on Tc-99m DTPA scan results.Öğe The Importance of the Trigeminal Cardiac Reflex in Rhinoplasty Surgery(Lippincott Williams & Wilkins, 2015) Özçelik, Derya; Toplu, Gaye; Türkseven, Arzu; Sezen, Gülbin; Ankaralı, HandanBackground Trigeminocardiac reflex (TCR) consists of bradycardia or asystole along with hypotension and apnea coinciding with stimulation of the trigeminal nerve. During rhinoplasty procedures, we noticed that local anesthetic solution (LAS) application to the columellar area results in bradycardia. We planned to conduct a randomized prospective study on 47 patients undergoing rhinoplasty to demonstrate the characteristics of TCR arising from the columella. Method Local anesthetic solution containing 2% prilocaine with 1:80,000 adrenaline was applied under standard general anesthesia protocol. In group 1 (study group, n = 24), 2 mL of LAS was applied to the columella. In group 2 (control group, n = 23), 2 mL of LAS was applied to the nasal dorsum. In group 3 (control group, n = 20), after LAS was applied to nasal dorsum in group 2, we waited for 10 minutes. Then, 2 mL of LAS was applied to the columella. Here, recordings were taken for the columella. Heart rate (HR) and blood pressure (BP) were recorded just before needle insertion (baseline level), at the time of needle insertion (NIT) to the columella or dorsum, and after the 1st, 5th, 10th, 30th, and 60th seconds. Results Transient bradycardia (>= 20% drop in HR) was observed in 33% of the patients in group 1. Decrease in HR compared to the baseline level in group 1 was significantly greater than that of groups 2 and 3 at all times (P <= 0.05). Systolic BP in NIT and in 60th second in group 1, only in NIT in group 2 was significantly lower than that of baseline levels (P <= 0.05). Conclusions We concluded that stimulation of a sensory branch of the trigeminal nerve in the columellar area leads to TCR under general anesthesia by eliciting clinical hypotension with a drop in systolic BP and in HR of more than 20% compared to the baseline level. Knowing the existence of a certain TCR area will be helpful to the surgeon and anesthesiologist to exercise extra vigilance and to make continuous and meticulous monitoring of the electrocardiogram, HR, and BP during which the TCR may be precipitated such as local anesthetic infiltration to the columellar area in rhinoseptoplasty operations.Öğe Neurotoxic effects of ketamine and different doses of ropivacaine administered intrathecally in rabbits(Turkiye Klinikleri, 2013) Sezen, Gülbin; Demiraran, Yavuz; Güven, Aysel; Ankaralı, Handan; Sevinç, Özdemir; Karagöz, İbrahimObjective: Although a variety of anesthetic medicines are used intrathecally, experimental neurotoxic studies on these drugs are not sufficient. In our study, we used immunocytochemical examination to assess the neurotoxic potential of ketamine and different doses of ropivacaine administered intrathecally. Material and Methods: Thirty rabbits were divided into five groups which were inserted spinal catheters under anesthesia. Each group received in a volume of 0.3 ml, as follows: the R0.2 group received 0.2% ropivacaine, the R0.75 group received 0.75% ropivacaine, the R1 group received 1.0% ropivacaine, the K group received preservative-free S (+) ketamine and the C group received 0.9% NaCl. The onset and duration of action were recorded by using Motor Dysfunction Index (MDI). Rabbits were observed for five days and then euthanasized. After catheters were removed, brains and spinal tissue samples were evaluated by light microscopy and immunocytochemical examination. Results: The longest onset of action was observed in the K group. Among the ropivacaine groups, the onset of action diminished and the duration of action extended with an increase in dose significantly. There was axonal degeneration in the R1 group, but this finding not reach significance. In the ketamine group, significant neuronal degeneration and reduction in number of neurons in the brain sections were observed. In the 1% ropivacaine group, a relative increase in neurofilament intensity was detected using immunocytochemical assessments in the medulla spinalis and brain sections. Conclusion: The intrathecal applications of 1% ropivacaine and ketamine can induce neurotoxic damage, despite a lack of observed functional neurologic deficits. © 2013 by Türkiye Klinikleri.Öğe The postoperative respiratory failure due to vocal cord polyp in laparoscopic bariatric surgery: A case report [Laparoskopik bariyatrik cerrahide vokal kord polibine ba?li postoperatif solunum yetmezli?i: Olgu sunumu](Anestezi Dergisi, 2015) Şeker, İlknur Suidiye; Sezen, Gülbin; Özlü, Onur; Güçlü, EnderObesity is a major risk factor of difficult intubation and mask ventilation during induction of anesthesia. Because of the obesity, the degree of concomitant lung and upper airway pathologies increase the obstructive and restrictive disorders of the airway functions. In this case the airway management of patient who had sleeve gastrectomy operation is presented. It was predicted to be a difficult intubation on the preanesthetic examination and also vocal cord polyps were established during the endotracheal intubation with fiberoptic bronchoscope under general anesthesia.Öğe Subanesthetic concentration of sevoflurane and desflurane were inhalated in rats; Liver and kidney toxicities and behavioural effects(2007) Sezen, Gülbin; Demiraran, Yavuz; Akbay, Buket Kocaman; Aksoy, K.A.Aim: Numerous studies have suggested that chronic exposure to trace levels of anesthetic gas is harmful to operating room personel. In this study, we aimed to the effects of subanesthetic doses of sevoflurane and desflurane on anxiety and hepatic and renal toxicities according to biochemical and histopathological changes in rats. Material and Methods: Total 24 rats were included study and three groups were formed as sevoflurane (% 0.1), desflurane (% 0.04) and control (3 L min -1 O 2). During four months, every day between 09.00-13.00 hours in the morning were inhaled with anesthetic agent determined concentrations. Anxiety were examined with Plus Maze Test; pre and post study urea, BUN, creatinine and GGT were examined in blood supplies. At the end of the study, rats were sacrificed for examined of kidney and liver histopathologically. Results: In the sevoflurane and desflurane groups increased the time spent within the closed pathways without motion. In the sevoflurane group; GGT, urea and BUN levels were elevated significantly. In the sevoflurane and desflurane groups hepatic congestion were examined significantly increased more than control group, focal necrosis increased in the sevoflurane group more than others. In the sevofluran group; focal lymphocytic infiltration and flatting in the tubuler epithelium were examined significantly higher than other groups. Conclusion: Our results were examined, subanesthetic doses of sevoflurane and desflurane were used increased to anxiety, caused of renal and hepatic damage at subclinic levels in rats.Öğe The Effects of Endotracheal Administration of N-Acetylcysteine on the Respiratory Functions(Düzce Üniversitesi, 2005) Demiraran, Yavuz; Annakkaya, Ali Nihat; Akçalı, Gülgün Elif; Yeşiloğlu, Reşat; Kocaman, Buket; Sezen, Gülbin; İskender, AbdulkadirIn this study, to investigate the effect on the per and postoperative respiratory complications of the administration of n-acetyl cystein as endotracheal during intubation to the smoker patients undergoing surgery was aimed. This study was planned as prospective, randomized, placebo controlled, double blinded and 40 patients as two groups. The study included between 20 to 60 years of age, ASA I-II, patients who were satisfied the following conditions; minimum 10 cigarettes per day for minimum 5 years and need to take general anesthesia. Chest radiography, respiratory functions test and arterial blood pressure of the patients were analyzed preoperatively. After intubation, 2 ml % 0,9 NaCl (normal saline) was given to group P (n=20) and 2 ml n-acetyl cystein was given to group N (n=20) via inside the intubation tube and for rapid absorption high pressure ventilation (20cmH2O) was applied several times. ECG, non - invasive arterial pressure, heart beat rate, peripheric arterial oxigen saturation and entidal carbondioxid were monitored. Blood pressure at 1 and 24 hours and respiratory function test and chest radiography at 24 hours were repeated post operative. Pre-operative FEV1/FVC in n-asetilcystein group was found significantly lower than placebo group (pÖğe Traumatic pulmonary pseudocyst: 2 case reports(Turkish Assoc Trauma Emergency Surgery, 2012) Erbaş, Mesut; Karapolat, Sami; Gezer, Suat; Sezen, Gülbin; Ateş, HakanTraumatic pulmonary pseudocysts (TPP) are cavitary lesions that are rarely seen after blunt thoracic traumas. Two male patients who were diagnosed with cystic lesions in the left lung after trauma were followed in our clinic with the diagnosis of TPP. Due to increase in cyst dimensions and wall tension, which were seen on the follow-up thorax tomography, surgical intervention was decided for both cases. The first case underwent cystotomy and capitonnage via thoracotomy, and was discharged without any complication. However, the second case was lost due to cardiac arrest during the operative preparations. Thorax tomography is an important method in the diagnosis and radiological follow-up of TPP. The surgery option should always be remembered for patients who show progression during the follow-up.
