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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 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 A comparison of transversus abdominis plane block guided with ultrasonography and local anesthetic infiltration in laparoscopic cholecystectomy operations(Kare Publ, 2018) Dost, Burhan; Sezen, Gülbin Yalçın; İskender, Abdülkadir; Özlü, OnurObjectives: The aim of this study was to compare a transversus abdominis plane (TAP) block guided with ultrasound (USG) and local anesthetic infiltration (LAI) in terms of the intraoperative and postoperative analgesia efficiency, intraoperative opioid need, and side effects in cases of laparoscopic cholecystectomy. Methods: A total of 75 patients classified as American Society of Anesthesiologists class I or II were included in this randomized, controlled, prospective study and divided into 3 groups. 20 mL of levobupivacaine 0.5% was applied around the trocar entrance site before the operation to group L (n=25), and 30 mL 0.25% levobupivacaine was applied with a USG-guided TAP block to group T (n=25). No TAP block or LAI was applied to the control group (n=25), group K. In the first 24 hours after surgery, an infusion of tramadol was administered with a controlled analgesia device. The intraoperative fentanyl use was recorded, and a visual analogue scale was administered to assess pain while resting (VAS rest) and upon coughing (VAS cough) at 1, 2, 4, 8, 12, 16, and 24 hours postoperative. An evaluation of shoulder pain and the consumption of analgesia in 24 hours were also recorded. Results: The VAS rest and VAS cough values, the dose of fentanyl used intraoperatively, and the total analgesia dose administered in 24 hours were compared between groups and there was no statistically significant difference detected (p>0.05). In group T, the vomiting rate 1 and 2 hours postoperative (20% and 12%, respectively) was significantly lower than in group K (64% and 44%, respectively). Conclusion: The efficiency of the analgesia provided after a laparoscopic cholecystectomy with a bilateral TAP block guided with USG and LAI was determined to be similar.Öğe Effect of anesthesiological strategies on neonatal bilirubin levels during cesarean section: a prospective and randomized trial(Springer Heidelberg, 2011) Demiraran, Yavuz; Albayrak, Mustafa; Şeker, İlknur Suidiye; Kaynak, Gürsel; İskender, Abdülkadir; Sezen, Gülbin Yalçın; Özdemir, İsmailPurpose Neonatal jaundice, a frequent problem in neonatology, can be influenced by many factors. Here, we sought to clarify the role of anesthesia and to compare the effects of various anesthesiological strategies on neonatal bilirubin levels during cesarean section. Methods We prospectively enrolled 167 ASA I-II status uncomplicated pregnant women who delivered by cesarean section as the study group. The patients were randomized based on anesthesiological strategy: inhalation (IA), spinal (SA), total intravenous (TIVA), and epidural anesthesia (EA) groups. Neonatal total (TB) and direct bilirubin (DB) levels at the 24th hour and 5th day of life and the need for phototherapy were compared between the groups. Results Direct bilirubin levels at 24th hour of SA group and EA group were higher compared to IA group (p = 0.008). When DB levels at fifth day were compared, levels in group TIVA were significantly higher than group SA (p = 0.019). TB levels at fifth day in group TIVA were higher than SA and EA groups (p = 0.05). The percentage of newborns needing phototherapy did not differ significantly among groups, but was highest in the TIVA group (25%), followed by the IA (15%), EA (10%) and SA (7%) groups (p = 0.08). Conclusions EA and SA at cesarean section seem to be better among the four anesthesia techniques considering neonatal hyperbilirubinemia. Our findings are consistent with the idea that anesthesia may be a risk factor for hyperbilirubinemia. Although anesthesia may not significantly increase the need for interventions such as phototherapy, it may increase the burden of time, labor and cost.Öğe Effect of Smoking on Reversing Neuromuscular Block(Aves, 2016) Öztürk, Ömür; Sezen, Gülbin Yalçın; Ankaralı, Handan; Özlü, Onur; Demiraran, Yavuz; Ateş, Hakan; Dost, BurhanObjective: Rocuronium is a non-depolarising, intermediate-acting, monoquaternary amino steroid and was brought into clinical use as a potentially ideal muscle relaxant. Post-operative residual curarisation (PORC) results from the prolonged effects of non-depolarising neuromuscular blocking agents. This is a common problem and seriously affects patient safety. No recent study has investigated the effects of sugammadex on smokers, which is often used to restore neuromuscular block and avoid PORC. This study compares the severity of the effects of sugammadex used for antagonising rocuronium bromide and antagonism durations in smokers and non-smokers. Methods: This randomised, prospective study included 40 patients scheduled for elective surgery and belonging to classes I and II based the American Society of Anesthesiologists classification, who were either smokers for at least 10 years or non-smokers. Patients underwent routine and neuromuscular monitoring. At induction, 2 mg kg(-1) propofol and 1 mcg kg(-1) intravenous fentanyl were applied. After the loss of eyelash reflex, 0.6 mg kg(-1) intravenous rocuronium was administered. Patients were intubated at train of four (TOF) 2. Anaesthesia was continued with 50% O-2 + 50% air and 2% sevoflurane. Rocuronium, 0.15 mg kg(-1), was administered at TOF 2 during the operation. At the end of the operation, 2 mg kg(-1) sugammadex was administered. The times until TOF 0.7, 0.8 and 0.9 were recorded. Results: Intubation time was 132.8 +/- 46.4 s for smokers and 127.6 +/- 32.7 s for non-smokers. After sugammadex administration, the time to TOF 0.7 was 153.3 +/- 54.7 s in smokers and 125 +/- 67.2 s in non-smokers. The times were 178.4 +/- 58.8 and 146.6 +/- 72.6 s for TOF 0.8 and 200.8 +/- 55.8 s and 170.4 +/- 77.8 s for TOF 0.9 in smokers and non-smokers, respectively. Conclusion: Although not statistically significant, the time to reach each TOF was longer for smokers. Larger populations and different perspectives are needed to find if sugammadex use is affected by smoking, which has negative effects on the body.Öğe Efficacy of Topical Levobupivacaine in Control of Postoperative Pain after Septoplasty(Bmc, 2010) Yılmaz, Süleyman; Akbay, Buket Kocaman; Yıldızbaş, Şahnur; Güçlü, Ender; Yaman, Hüseyin; Sezen, Gülbin YalçınObjective: To search the efficacy of using Merocele (Medtronic, Minneapolis, MN) soaked with 5 mL of levobupivacaine hydrocloride as a nasal pack in control of postoperative pain after septoplasty. Design: The study was designed as a prospective, double-blind, randomized, controlled study. Forty-one patients who underwent septoplasty operation were included in the analysis. Setting: A tertiary referral hospital in Turkey. Material and Methods: Forty-one patients undergoing septoplasty were divided into two groups. At the end of the operation, Merocele packs were placed inside the nasal cavity. In the levobupivacaine group, each Merocele pack was soaked with 5 mL of levobupivacaine hydrochloride (25 mg/10 mL), and in the control group, Merocele packs were soaked with 5 mL of saline. Main Outcome Measures: Postoperative pain levels were recorded using a visual analogue scale (VAS score, 0-100) at 30 minutes and 1, 2, 8, 12, and 24 hours. Results: We did not find any significant difference between groups regarding age, gender, American Society of Anesthesiologists status, and body mass index. Postoperative VAS values at 30 minutes and 1, 2, 8, and 12 hours were significantly lower in the levobupivacaine group compared with the control group (p < .05). The need for supplemental analgesia was significantly lower in the levobupivacaine group compared with the control group (p < .01) Conclusion: Postoperative pain after septoplasty owing to nasal packing is an important problem, and using levobupivacaine-soaked Merocele as a nasal pack after septoplasty is an effective method for the control of this pain. It is a very easy, effective, and quick method and it improves patient comfort after septoplasty.Öğe Epidural anestezide %0.5 bupivakain ve % 0.5 levobupivakain kullanımının QT dispersiyonu ve hemodinamik etkilerinin karşılaştırılması(2010) Özdemir, Yaşar; Sezen, Gülbin Yalçın; Demiraran, Yavuz; Yazıcı, Mehmet; İskender, Abdülkadir; Yücel, İstemiAmaç: Bu çalışmanın amacı, epidural yolla uygulanan %0.5 bupivakain ile %0.5 levobupivakainin; hemodinamik ve QT dispersiyonu etkilerinin değerlendirilmesidir. Yöntem: Epidural anestezi ile operasyon planlanan 60 hasta çalışmaya dahil edildi. Randomize olarak 2 gruba ayrıldı; Grup B'de (n30) 15 mL %0.5'lik bupivakain, Grup L'de (n30) 15 mL %0.5'lik levobupivakain epidural yoldan uygulandı. Peroperatif dönemde sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), ortalama kan basıncı (OKB), kalp atım hızı (KAH), periferik oksijen satürasyonu (Sp02), solunum sayısı ve yan etkiler kaydedildi. Postoperatif dönemde motor blok geri dönüş süreleri 30 dk.'lık periyotlarla değerlendirildi ve total blok süreleri kaydedildi. Preoperatif, ilk epidural anestezi uygulamasından 30 dk. sonra ve postoperatif 24. saatte EKG çekildi ve bir kardiyolog tarafından değerlendirildi. Bulgular: Motor blok gelişimi ve total blok süreleri Grup B'de yüksekti (p0.05) ve 180. dk. OKB Grup B'de azalmıştı (p0.05). En uzun düzeltilmiş QT zamanı ve en kısa düzeltilmiş QT zamanı Grup B'de uzamıştı (p0.05). Hipotansiyon görülme sıklığında ise Grup B'de artış saptandı (p0.05). Sonuç: Kardiyak problemleri olan, daha az motor blokaj istenen hastalarda levobupivakainin bupivakaine iyi bir alternatif olabileceğini düşünmekteyiz.Öğe Re: Passive Smoking Also Affects Recovery from Anaesthesia Reply(Aves, 2017) Öztürk, Ömür; Sezen, Gülbin Yalçın; Ankaralı, Handan; Özlü, Onur; Demiraran, Yavuz; Ateş, Hakan; Dost, Burhan…Öğe Re: The Negative Influence of Cigarette Smoke on Passive Smokers-Deteriorated Pulmonary Function Tests and Increased Urine Cotinine Levels(Aves, 2019) Öztürk, Ömür; Sezen, Gülbin Yalçın; Ankaralı, Handan; Özlü, Onur; Demiraran, Yavuz; Ateş, Hakan; Dost, Burhan…Öğe Sigara Kullanımının Nöromuskuler Bloğun Geri Döndürülmesi Üzerine Etkisi(2016) Öztürk, Ömür; Sezen, Gülbin Yalçın; Ankaralı, Handan; Özlü, Onur; Demiraran, Yavuz; Ateş, Hakan; Dost, BurhanAmaç: Rokuronyum orta etki başlama süresine sahip, aminosteroid yapıda non depolarizan steroid kas gevşeticidir ve ideal kas gevşetici bulma çabaları sonucunda klinik amaçlı kullanılmaya başlanmıştır. Postoperatif kürarizasyon (PORC) non-depolarizan kas gevşeticilerin etkisinin uzaması sonucu ortaya çıkar. Bu önemli sorun günümüzde hala yaygındır ve hasta güvenliğini ciddi bir şekilde etkilemektedir. Literatür taramamızda sigara içiminin nöromuskuler bloğun etkisini ortadan kaldırmak ve PORC'dan kaçınmak için daha sık kıllanılan sugammadex üzerine etkisini araştıran bir çalışma bulunmamıştır. Bu çalışmanın amacı sigara kullanımının rokuronyum bromürü antagonize etmek için kullanılan sugammadexin etkinliği üzerine etkisini araştırmaktır. Yöntemler: Prospektif randomize çalışmaya ASA 1-2; son 10 yıldır sigara içen veya hiç içmeyen elektif cerrahi hazırlığı yapılan hastalar dahil edildi. Hastalara rutin vital bulgu monitorizasyonu ve nöromuskuler monitörizasyon uygulandı. Anestezi indüksiyonunda 2 mg kg-1 propofol, 1 mcg kg-1 fentanyl IV verildi. Kornea refleksi kaybolduktan sonra 0,6 mg kg-1 rokuronyum bromur IV uygulandı. Dörtlü uyarı (TOF) 2 düzeyine ulaşıldığında hastalar entübe edildi. İdame %50 O2 , %50 hava ve %2 sevoflurane ile sağlandı. TOF 2 olduğunda 0,5 mg kg-1 rokuronyum bromür uygulandı. Operasyon sonunda 2 mg kg-1 sugammadeks uygulandı. TOF değerinin 0,7-0,8-0,9 olma süreleri kaydedildi. Bulgular: Sigara içenlerde entübasyon süresi 132,846,4 sn, iç- meyenlerde 127,632,7 sn bulundu. Sugammadeks uygulandıktan sonar sigara içenlerde TOF 0,7 153,354,7 sn ile içmeyenlerde 12567,2 sn bulundu. TOF 0,8'e ulaşma süresi sigara içenlerde 178,458,8 ile içmeyenlerde 146,672,6 sn bulundu. TOF 0,9'a ulaşma süresi sigara içenlerde 200,855,8 sn iken sigara içmeyenlerde 170,477,8 sn bulundu. Sonuç: İstatistiksel olarak anlamlı olmasada TOF süreleri sigara içenlerde daha uzun bulundu. Sigara kullanımının sugammadeks kullanımı üzerine etkisinin araştırılması için daha geniş örneklem gruplarında yapılan çalışmalara ihtiyaç vardır.Öğe Topical Levobupivacaine Efficacy in Pain Control after Functional Endoscopic Sinus Surgery(Sage Publications Ltd, 2013) Yılmaz, Süleyman; Yıldızbaş, Şahnur; Güçlü, Ender; Yaman, Hüseyin; Sezen, Gülbin YalçınObjective. The aim of this study was to find out the efficacy of a polyvinyl alcohol (PVA) sponge (Merocel Kennedy; Medtronic Xomed, Jacksonville, Florida) sinus pack soaked with levobupivacaine hydrochloride to control postoperative pain and analgesic need following functional endoscopic sinus surgery (FESS). Study Design. The study was designed as a prospective, double-blind, randomized, controlled study. Forty-one patients who underwent FESS were included in the analysis. Setting. A tertiary referral hospital in Turkey. Materials and Methods. Patients who underwent FESS were divided into 2 groups. The PVA sponge sinus packs were soaked with 5 mL of levobupivacaine hydrochloride (chirocaine 25 mg/10 mL; Abbott, Nycomed Pharma AS, Elverum, Norway) in group I and with 5 mL of saline in group II. Main Outcome Measures. Postoperative pain levels were recorded using a visual analog scale (VAS score, 0-100) at 30 minutes and 1, 2, 8, 12, and 24 hours. Results. There were no statistically significant differences between groups regarding age, sex, and American Society of Anesthesiologists status. Postoperative VAS values at 30 minutes and 1, 2, 8, 12, and 24 hours were significantly lower in group I than in group II (P < .05). Supplemental analgesia amount was significantly lower in group I than in group II (P = .003). Conclusion. Using levobupivacaine-soaked PVA sponge sinus packs after FESS is an effective, easy, and quick method to control postoperative pain, and it improves patient comfort and tolerability.
