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Abdominal blockage of iliohypogastric and ilio-inguinal nerves for management of post-caesarean pain: A novel method
(SA MEDICAL ASSOC HEALTH & MEDICAL PUBL GROUP, 2012) Boztosun, Abdullah; Duger, Cevdet; Kosar, Mehmet Ilkay; Salk, Ismail; Gursoy, Sinan; Muderris, Iptisam Ipek; Yanik, Ali
Objective. The aim of this study was to compare pain relief after caesarean section achieved by an intra-abdominal iliohypogastric and ilio-inguinal (IHII) nerve block with levobupivacaine with that in patients given a placebo. Study design. A total of 60 healthy women scheduled for caesarean delivery under general anaesthesia were enrolled in the study. The patients were randomised to an abdominal IHII nerve block with levobupivacaine (levobupivacaine group) or administration of saline (placebo group). Instead of the classic percutaneous method, the block was administered intra-operatively from the peritoneal aspect. Scores on a visual analogue scale (VAS) at 2, 6, 12 and 24 hours, adverse effects, morphine consumption and success of blockage by a pinprick test were recorded. Results. In the levobupivacaine group, the pinprick test showed there to be successful bilateral block in 22 patients and unilateral block in 5, while the block failed in 3. No block was recorded in the placebo group. When morphine consumption at 12 and 24 hours were compared, consumption was found to be significantly low for both time points in the levobupivacaine group. VAS scores 2, 6 and 12 hours after the operation were also significantly lower in the levobupivacaine group. Conclusion. A block of the IHII nerves from inside the abdomen just before abdominal closure appears to be an effective and safe way of relieving pain after caesarean section.
Addition of Dexmedetomidine or Lornoxicam to Prilocaine in Intravenous Regional Anaesthesia for Hand or Forearm Surgery A Randomized Controlled Study
(ADIS INT LTD, 2009) Kol, Iclal O.; Ozturk, Hayati; Kaygusuz, Kenan; Gursoy, Sinan; Comert, Baris; Mimaroglu, Caner
Background and objectives: Intravenous regional anaesthesia (IVRA) is a simple and cost-effective technique that is ideally suited for surgery involving the distal arm. This study compared the effect of lornoxicam or dexmedetomidine in IVRA with prilocaine in patients who underwent hand or forearm surgery. Methods: This randomized, double-blind study enrolled 75 patients scheduled for hand or forearm surgery. IVRA was achieved with 2% prilocaine 3 mg/kg in the control group (n = 25), 2% prilocaine 3 mg/kg plus dexmedetomidine 0.5 mu g/kg in the dexmedetomidine group (n = 25), and 2% prilocaine 3 mg/kg plus lornoxicam 8 mg in the lornoxicam group (n = 25). In all groups, 0.9% NaCl solution was added to make up a total volume of 40 mL. Sensory and motor block onset and recovery times, haemodynamic variables, visual analogue scale (VAS) pain and sedation scores, duration of analgesia, total analgesic consumption over 24 hours, adverse effects and quality of anaesthesia were recorded. Results: Sensory block onset was shorter and sensory block recovery time longer in the dexmedetomidine group compared with the lornoxicam and control groups (p < 0.05). Sensory and motor block recovery times and duration of analgesia for tourniquet were prolonged in the dexmedetomidine and lornoxicam groups compared with the control group (p < 0.05). Median VAS scores for tourniquet pain in the dexmedetomidine and lornoxicam groups were lower than that of the control group at 15 and 30 minutes (p < 0.05). Postoperatively, the duration of analgesia time was longer and median VAS scores were lower during the first 12 hours in the dexmedetomidine and lornoxicam groups compared with the control group (p < 0.05). Total analgesic consumption over 24 hours was lower in the dexmedetomidine and lomoxicam groups compared with the control group (p < 0.05). Anaesthesia quality as determined by the anaesthesiologist was better in the dexmedetomidine and lomoxicam group than in the control group (p < 0.05). Conclusions: Addition of dexmedetomidine or lornoxicam to prilocaine in IVRA decreased VAS pain scores, improved anaesthesia quality and decreased analgesic requirement. We suggest that addition of dexmedetomidine or lornoxicam at the doses used in this study to IVRA with prilocaine in this setting can be useful without causing adverse effects. No hypotension, bradycardia or hypoxia requiring treatment was seen in any of the patients. Addition of dexmedetomidine had a more potent effect, shortening sensory block onset time and prolonging sensory block recovery time more than lornoxicam.
Additive interaction of intraperitoneal dexmedetomidine and topical nimesulide, celecoxib, and DFU for antinociception
(ELSEVIER SCIENCE BV, 2007) Karadas, Baris; Kaya, Tijen; Gulturk, Sefa; Parlak, Ahmet; Gursoy, Sinan; Cetin, Ali; Bagcivan, Ihsan
Nimesulide, celecoxib, and DFU (5, 5-dimethyl-3-(3-fluorophenyl)-4-(4-methylsulphonyl)phenyl-2(5H)-furanone) are nonsteroidal antiinflammatory drugs (NSAIDs) with selective cyclo-oxygenase (COX)-2 blocking properties and have potent analgesic and anti-inflammatory activities in oral and parenteral administrations. Dexmedetomidine, a highly selective alpha(2)-adrenoceptor agonist, is an extremely potent antinociceptive agent. The present study was conducted to evaluate the antinociception induced by nimesulide, celecoxib, and DFU when topically applied on the tail in the absence or presence of intraperitoneal dexmedetomidine. Antinociception was measured in the radiant tail-flick test after immersion of the tail of rat into a solution of dimethyl sulfoxide (DMSO) containing nimesulide, celecoxib, or DFU. Antinociceptive effect of all drugs peaked at 60 min and decreased gradually to baseline levels at 240 min. Nimesulide had a potency lower than those of celecoxib, and DFU. The antinociceptive effect of dexmedetomidine was blocked by systemic pretreatment of selective alpha(2)-adrenoceptor antagonist, atipamezole. This suggests that antinociceptive effects of dexmedetomidine involve alpha(2)-adrenoceptors. Combination of topical COX-2 inhibitors with intraperitoneal dexrnedetomidine yielded additive analgesic effect. These results demonstrate an additive interaction between topical COX-2 inhibitors with intraperitoneal dexmedetomidine. These observations are significant for physicians to combine selective COX-2 inhibitors and dexmedetomidine in the management of pain. (c) 2006 Elsevier B.V. All rights reserved.
Altered spontaneous contractions of the ileum by anesthetic agents in rats exposed to peritonitis
(W J G PRESS, 2009) Aydin, Cengiz; Bagcivan, Ihsan; Gursoy, Sinan; Altun, Ahmet; Topcu, Omer; Koyuncu, Ayhan
AIM: To investigate in vitro effects of propofol, midazolam and dexmedetomidine, which are commonly used anaesthesic or sedatives, on spontaneous contractions of the ileum both in normal rats and those exposed to hyperdynamic peritonitis. METHODS: Spontaneous contractions of isolated ileum muscle segments from sham operated rats and those exposed to peritonitis, were studied in vitro. The amplitude and the frequency of spontaneous contractions of ileum muscle segments were studied after adding dexmetetomidine, propofol, and midazolam to the organ bath in a cumulative manner. RESULTS: Both amplitude (85.2 +/- 6.6 vs 47.4 +/- 7.1) and frequency (32.8 +/- 4.6 vs 20.2 +/- 3.9) of spontaneous contractions in ileum smooth muscle segments were decreased significantly in the peritonitis group compared to the control group (P < 0.05). Dexmedetomidine significantly increased the amplitude of spontaneous contractions (85.2 +/- 6.6 vs 152.0 +/- 5.4, P < 0.05) whereas, propofol (85.2 +/- 6.6 vs 49.6 +/- 4.8, P < 0.05) and midazolam (85.2 +/- 6.6 vs 39.2 +/- 4.5, P < 0.05) decreased it in both control and peritonitis groups. The frequency of spontaneous contractions were significantly decreased by propofol in both control (32.8 +/- 4.6 vs 18.2 +/- 3.4, P < 0.05) and peritonitis groups 20.2 +/- 3.9 vs 11.6 +/- 3.2, P < 0.05). Dexmedetomidine and midazolam did not cause significant changes in the number of spontaneous contractions in both control and the peritonitis groups (P > 0.05). CONCLUSION: Propofol, midazolam and dexmedetomidine have various in vitro effects on spontaneous contractions of the rat ileum. While dexmedetomidine augments the spontaneous contraction of the rat ileum, propofol attenuates it. However, the effects of these compounds were parallel in both control and peritonitis groups. (C) 2009 The WIG Press and Baishideng. All rights reserved.
Anesthetic and analgesic effects in patients undergoing a lumbar laminectomy of spinal, epidural or a combined spinal-epidural block with the addition of morphine
(ELSEVIER SCI LTD, 2012) Duger, Cevdet; Gursoy, Sinan; Karadag, Ozen; Kol, Iclal Ozdemir; Kaygusuz, Kenan; Ozal, Hasan; Mimaroglu, Caner
This study was designed to evaluate the anesthetic, analgesic and side effects of spinal, epidural and combined spinal-epidural anesthesia with the addition of morphine for lumbar laminectomy. A total of 66 patients undergoing lumbar laminectomy were included in the present study of whom 64 completed the study. Patients were randomly divided into three groups: (i) spinal anesthesia - the SA group; (ii) epidural anesthesia - the EA group; and (iii) combined spinal-epidural anesthesia - the CA group. Demographical data, surgical times and peak sensory levels of groups were similar. Heart rate, mean arterial pressure, and peripheral oxygen saturation did not differ between the three groups. No differences were observed intraoperatively in Ramsey sedation scale (RSS) scores between the groups, but postoperatively, although RSS scores were similar for the EA and CA groups, they were significantly lower for the SA group. The postoperative visual analogue scale pain scores were higher in the SA group compared to the EA and the CA groups except for the second postoperative hour. Time-to-use of the first patient controlled analgesia was similar for all groups. The total consumption of morphine over the 24-hour study period was significantly higher in the SA group compared to the EA and the CA groups. Postoperative nausea and vomiting frequencies were higher in SA group, but pruritus frequency was lower than the EA and the CA groups. In conclusion, although spinal, epidural, and combined spinal-epidural anesthesia are adequate and effective for lumbar laminectomies, epidural and combined spinal-epidural anesthesia techniques are more effective than spinal anesthesia for postoperative analgesia and sedation with lesser side effects. (C) 2011 Elsevier Ltd. All rights reserved.
Aspiration and Death from Amitraz-Xylene Poisoning
(Medi+World Int, 2006) Beyaztas, Fatma Yucel; Gursoy, Sinan; Demirel, Yeltekin; Kaygusuz, Kenan; Mimaroglu, Caner
Amitraz is an acaricide and insecticide indicated for the treatment of dogs and for the control of ticks and mites in cattle and sheep. We report the clinical, laboratory and postmortem features of a suicide case by ingestion of amitraz. The major clinical findings were unconsciousness, respiratory failure requiring mechanical ventilation, miosis, hypothermia and bradycardia. The laboratory findings were hyperglycemia. The postmortem findings were pulmonary edema and congestion in the lungs and fatty changes in the liver. In this case report, we concluded that xylene aspiration was responsible for pulmonary edema and congestion in the lungs, and the aspiration pneumonitis rapidly led to septicemia which was the probable cause of death. This case was reported because of the limited information in the literature on this subject.
Attenuation of morphine antinociceptive tolerance by cannabinoid CB1 and CB2 receptor antagonists
(SPRINGER JAPAN KK, 2015) Altun, Ahmet; Yildirim, Kemal; Ozdemir, Ercan; Bagcivan, Ihsan; Gursoy, Sinan; Durmus, Nedim
Cannabinoid CB1 and CB2 receptor antagonists may be useful for their potential to increase or prolong opioid analgesia while attenuating the development of opioid tolerance. The aim of this study was to investigate the effects of AM251 (a selective CB1 antagonist) and JTE907 (a selective CB2 antagonist) on morphine analgesia and tolerance in rats. Adult male Wistar albino rats weighing 205-225 g were used in these experiments. To constitute morphine tolerance, we used a 3 day cumulative dosing regimen. After the last dose of morphine was injected on day 4, morphine tolerance was evaluated by analgesia tests. The analgesic effects of morphine (5 mg/kg), ACEA (a CB1 receptor agonist, 5 mg/kg), JWH-015 (a CB2 receptor agonist, 5 mg/kg), AM251 (1 mg/kg) and JTE907 (5 mg/kg) were considered at 30-min intervals (0, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests. Our findings indicate that ACEA and JWH907 significantly increased morphine analgesia and morphine antinociceptive tolerance in the analgesia tests. In contrast, the data suggested that AM251 and JTE907 significantly attenuated the expression of morphine tolerance. In conclusion, we observed that co-injection of AM251 and JTE907 with morphine attenuated expression of tolerance to morphine analgesic effects and decreased the morphine analgesia.
Comparison of In Vitro Effects of Opioid Analgesics on Spontaneous Proximal and Distal Colon Contractions in Healthy Rats and Rats with Peritonitis
(AVES, 2018) Ersan, Idris; Gursoy, Sinan; Avci, Onur; Altun, Ahmet; Bagcivan, Ihsan; Duger, Cevdet; Kol, Iclal Ozdemir; Kaygusuz, Kenan; Mimaroglu, Mehmet Caner
Objective: The goal of this study was to investigate and compare the effects of opioids on proximal and distal colon contractions in normal rats and rats with peritonitis, with and without the presence of naloxone in the environment. Methods: The study was approved by Cumhuriyet University Ethics committee. In this study, 16 Wistar Albino male rats were used. Rats were divided into two groups. Peritonitis was induced using a cecum ligation and perforation method, 24 h before the tissues of rats in the peritonitis group were collected, and sham surgery was performed 24 h before the tissues of rats in the control group were collected. Twenty-four hours after the surgery, rats' organs were harvested and hung in organ baths. Concentration-dependent inhibitory effects of morphine and meperidine on spontaneous intestinal movements were observed. Any differences between the groups were tested using the Kruskal-Wallis test, and any differences between the groups were tested using the Tukey test. Results: No significant difference was observed between the proximal and distal colon smooth muscle contraction responses in both groups after 80 mM Potassium Chloride (KCl) injection (p>0.005). In the peritonitis group, amplitudes and frequencies of spontaneous contractions in proximal and distal colon significantly increased (p<0.05). Drugs decreased the amplitude and frequency responses in the control group (p<0.05). In the peritonitis group, whereas morphine decreased the amplitude and frequency responses in comparison with the control group (p<0.05), meperidine did not cause any significant changes (p>0.05). In both groups, adding naloxone to the organ baths before adding opioids completely blocked the morphine's inhibitory effect on the amplitude and frequency (p<0.05), but it could not completely block the inhibition caused by meperidine. Conclusion: Morphine and meperidine exhibit an inhibitory effect on the intestinal motility in both groups. This effect can be blocked by naloxone completely in morphine, and partially in meperidine.
A comparison of sedation with dexmedetomidine or propofol during shockwave lithotripsy: A Randomized controlled trial
(LIPPINCOTT WILLIAMS & WILKINS, 2008) Kaygusuz, Kenan; Gokce, Gokhan; Gursoy, Sinan; Ayan, Semih; Mimaroglu, Caner; Gultekin, Yener
BACKGROUND: Dexmedetomidine, because it has both sedative and analgesic properties, may be suitable for conscious sedation during painful procedures. Extracor-Poreal shockwave lithotripsy (ESWL) is a minimal to mildly painful procedure that requires conscious sedation. We thus evaluated the utility of dexmedetomidine compared with propofol during an ESWL procedure. METHODS: Forty-six patients were randomly allocated into two groups to receive either dexmedetomidine or propofol for elective ESWL. Dexmedetomidine was infused at 6 mu g center dot kg(-1) center dot h(-1) for 10 min followed by an infusion rate of 0.2 mu g center dot kg(-1) center dot h(-1). Propofol was infused at 6 mg center dot kg(-1) center dot h(-1) for 10 min followed by an infusion of 2.4 mg center dot kg(-1) center dot h(-1). Fentanyl 1 mu g/kg IV was given to all patients 10 min before ESWL. Pain intensity was evaluated with a visual analog scale at 5-min intervals during ESWL (10-35 min). Sedation was determined using the Observer's Assessment of Alertness/Sedation. The Observer's Assessment of Alertness/ Sedation scores and hemodynamic and respiratory variables were recorded regularly during ESWL (35 min) and up to 85 min after. RESULTS: Forty patients were evaluated. Visual analog scale values with dexmedetomidine were significantly lower than those with propofol only at the 25-35 min assessments (P < 0.05). During sedation, the respiratory rate with dexmedetomidine was significantly slower but Spo(2) was significantly higher than with propofol (P < 0.05). Other clinical variables were similar (P > 0.05). CONCLUSION: A combination of dexmedetomidine with fentanyl can be used safely and effectively for sedation and analgesia during ESWL.
Comparison of the Effects of Desflurane and Sevoflurane on Middle Ear Pressure: A Randomized Controlled Clinical Trial
(KARGER, 2013) Duger, Cevdet; Dogan, Mansur; Isbir, Ahmet Cemil; Kol, Iclal Ozdemir; Gursoy, Sinan; Kaygusuz, Kenan; Sahin, Omer Fatih; Uysal, Ismail Onder; Mimaroglu, Caner
Objective: The aim of the present study was to compare the effects of two inhalation anesthetics, desflurane and sevoflurane, on middle ear pressure. Methods: After we obtained written consent from the patients and the approval from our institutional ethical committee, we included 56 ASA I-II patients aged between 18 and 60 years in this study. They were randomly divided into two groups of 28 patients each. Desflurane 4-6% (Group D) or sevoflurane 1-2% (Group S) were used for anesthesia management in patients. Baseline tympanometry was carried out and recorded before the induction of anesthesia on both ears, and 3 more measurements were done and recorded 5, 15 and 30 min after induction. Results: In both groups, middle ear pressure values were found to be significantly elevated when compared to baseline measurements (p < 0.05). When middle ear pressure was compared between the groups, no difference was found between the values obtained at baseline and at 5 min in Group S, while especially the values obtained at 15 min revealed significantly higher middle ear pressures in Group D. Conclusion: It was observed that the increase in middle ear pressure caused by sevoflurane was significantly lower than that caused by desflurane. (C) 2013 S. Karger AG, Basel
Controlled Hypotension With Desflurane Combined With Esmolol or Dexmedetomidine During Tympanoplasty in Adults: A Double-Blind, Randomized, Controlled Trial
(ELSEVIER SCIENCE INC, 2009) Kol, Iclal Ozdemir; Kaygusuz, Kenan; Yildirim, Altan; Dogan, Mansur; Gursoy, Sinan; Yucel, Evren; Mimaroglu, Caner
BACKGROUND: Controlled hypotension is a technique that is used to limit intraoperative blood loss to provide the best possible Surgical field during surgery. OBJECTIVE: The aim of this double-blind, randomized, controlled study was to compare the effects of desflurane combined with esmotol or dexmedetomidine on the amount of blood in the surgical field, recovery time, and tolerability in adult patients undergoing tympanoplasty. METHODS: Turkish patients aged IS to 60 years, classified as American Society of Anesthesiologists physical status I or II, who were scheduled for tympanoplasty were randomly divided into 2 groups: the esmolol group or the dexmedetomidine group. After the anesthesia induction in the esmolol group, a loading dose of esmolol was infused intravenously over 1 minute at 1 mg/kg, followed by a maintenance rate of 0.4 to 0.8 mg/kg/h. In the dexmedetomidine group, a loading dose of dexmedetomidine was infused intravenously over 10 minutes at a rate of 1 mu g/kg, followed by a maintenance rate of 0.4 to 0.8 mu g/kg/h. The infusion rates were then titrated to maintain mean arterial pressure (MAP) of 65 to 7 5 mm Hg. General anesthesia was maintained with desflurane 4% to 6%. Heart rate (HR) and MAP were recorded during anesthesia. The following 6-point scale was used to assess the amount of bleeding in the operative field: 0 = no bleeding, a virtually bloodless field; 1 = bleeding that was so mild that it was not a surgical nuisance; 2 = moderate bleeding that was a nuisance but did not interfere with accurate dissection; 3 = moderate bleeding that moderately compromised surgical dissection; 4 = bleeding that was heavy but controllable and that significantly interfered with surgical dissection; and 5 = massive bleeding that was uncontrollable and made dissection impossible. Scores ! 2 were considered to be optimal surgical conditions. The sedation score was determined at 15, 30, and 60 minutes after tracheal extubation using the following scale: 1. = anxious, agitated, or restless; 2 cooperative, oriented, and tranquil; 3 = responsive to commands; 4 = asleep, but with brisk response to light, glabellar tap, or loud auditory stimulus; 5 = asleep, sluggish response to glabellar tap or auditory stimulus; and 6 = asleep, no response. Time to extubation and to total recovery from anesthesia (Aldrete score >= 9 on a scale of 0-10), adverse effects (eg, intraoperative hypotension [blood pressure <65 mm Hg], bradycardia [HR <50 beats/min]), intraoperative fentanyl consumption, and postoperative nausea and vomiting were recorded. Arterial blood gas analysis and kidney and liver function tests were conducted. All patients were evaluated by the same attending surgeon and anesthesiologist, both of whom were blinded to the administered study drugs. RESULTS: Fifty-two consecutive white patients undergoing tympanoplasty were identified. Two patients had to be excluded because of hypertension and 2 refused to participate. Forty-eight patients were equally randomized to either the esmolol group (n = 24 [16 women, 8 men]; mean [SD] age, 38.4 [10.5] years) or the dexmedetomidine group (n = 24 [17 women, 7 men]; mean age, 35.5 [14.7] years). Sedation scores were not collected for I patient in the esmolol group; therefore, analysis was conducted for 23 patients. The median (range) of the scores for the amount of blood in the surgical field in the esmolol and dexmedetomidine groups was 1 (0-3) and 1 (0-2), respectively (P = NS). Mean intracoperative fentanyl consumption in the esmolol group was significantly higher than in the dexmedetomidine group (50.0 [3-0] vs 25.0 [2-5] mu g/min; P = 0.002). In the esmolol group, the mean times to extubation and to recovery from anesthesia were significantly shorter than those of the dexmedetomidine group (7.0 [1.4] vs 9.1 [1.9] minutes, respectively; 5.9 [2.1] vs 7.9 [2.3] minutes; both, P = 0.001). The mean sedation scores were significantly lower in the esmolol group (n = 23, because of intent-to-treat analysis) compared with the dexmedetomidine group at 15 minutes (2.5 [0.6] vs 3.6 [0.5]; P = 0.001) and 30 minutes (2.6 [0.6] vs 3.3 [0.6]; P = 0.001) postoperatively. No significant differences were found between the study groups in regard to blood urea nitrogen or creatinine concentration, aspartate aminotransferase or alanine aminotransferase activities, pH, partial pressure of carbon dioxide, or bicarbonate, before or after the operation. CONCLUSIONS: Both esmolol and dexmedetomidine, combined with desflurane, provided an effective and well-tolerated method of achieving controlled hypotension to limit the amount of blood in the surgical field in these adult patients undergoing tympanoplasty. Esmolol was associated with significantly shorter extubation and recovery times and significantly less postoperative sedation compared with dexmedetomidine. (Curr Ther Res Clin Exp. 2009;70:197-208) (C) 2009 Excerpta Medica Inc.
Dexmedetomidine and remifentanil as adjuncts to total intravenous anesthesia with propofol
(ANAESTHESIA PAIN & INTENSIVE CARE, 2017) Subasi, Hatice; Kol, Iclal Ozdemir; Duger, Cevdet; Kaygusuz, Kenan; Isbir, Ahmet Cemil; Gursoy, Sinan; Mimaroglu, Caner
Aim: The aim was to compare the effects of dexmedetomidine and remifentanyl in total intraveous anesthesia (TIVA) in laparoscopic cholecystectomy operations. Methodology: Forty, 18-60 years old, elective laparoscopic cholecystectomy patients were included in the study. In Group D, TIVA was performed by 150 mu g/kg/min propofol and 0.5 mu g/kg/h dexmedetomidine infusions. In Group R patients, TIVA was performed with 150 mu g/kg/min propofol and 0.5 mu g/kg/min remifentanil infusions. Systolic blood pressure, heart rate, SpO(2), end tidal CO2 were recorded. All infusions were terminated at the end of surgery. Adequate spontaneous respiration, extubation, and response to verbal commands; and Aldrete score >= 9 times, postoperative pain scores and vital parameters in the postoperative period were recorded. Patient-controlled analgesia pump was used in all postoperative patients. Total analgesic consumption, patients' first analgesic needs were recorded. Results: Intraoperative Systolic blood pressure, diastolic blood pressure and heart rate values remained significantly lower in remifentanyl group compared to those in dexmedetomidine group (p < 0.05). First postoperative analgesia time was shorter and hemodynamic parameters were significantly higher in this group (p < 0.05). Postoperative recovery of dexmedetomidine group remained more stable in terms of VAS values (p < 0.05). Conclusions: Remifentanil provides a potent intraoperative anesthesia compared with dexmedetomidine; however, dexmedetomidine may be considered in TIVA as an option for a stable postoperative recovery.
Effect of Chronic Knee Pain on Cognitive Function: Clinical Study
(INFORMA HEALTHCARE, 2014) Isbir, Ahmet Cemil; Duger, Cevdet; Mimaroglu, Caner; Kol, Iclal Ozdemir; Kaygusuz, Kenan; Gursoy, Sinan
Objectives: Chronic knee pain is a clinical problem that causes inconvenience in social, familial, and business environments. In clinic, while etiologies of chronic knee pain are generally known, its effects on cognitive functions are not fully understood. This study aims to measure and evaluate the relationship between cognitive function and chronic knee pain. Methods: Ninety-eight patients between 18 and 70 years of age having knee pain for at least 6 months were included in the study. Two groups were divided between A1 and A2, both patients of chronic knee pain. Cognitive functions were evaluated in the A1 group before treatment and in the A2 group after taking treatment. Both groups had the same number of patients [N = 98]. The Montreal Cognitive Assessment [MOCA] was applied to the patients before and after treatment. The patients with a MOCA score 26 and over were accepted as normal in terms of cognitive functions. Results: The MOCA score of the A2 group was significantly higher than that of A1 group. Visual analog scale values in group A2 were significantly decreased compared to A1. Although orientation scores were decreased, patients in group A2 showed a statistically significant increase in cognitive functional indicators like visual functions, language, abstract thinking, and delayed recall compared with group A1. Conclusions: The chronic knee pains might lead to cognitive function disorders in the long term. This can be prevented with the effective treatment of pain so that quality of life of patients can be increased. Moreover, the use of costly diagnosis and treatment methods can be prevented.
Effects of Adding Dexmedetomidine to Levobupivacaine in Axillary Brachial Plexus Block
(ELSEVIER SCIENCE INC, 2012) Kaygusuz, Kenan; Kol, Iclal Ozdemir; Duger, Cevdet; Gursoy, Sinan; Ozturk, Hayati; Kayacan, Ulku; Aydin, Rukiye; Mimaroglu, Caner
BACKGROUND: Although several studies have described effects of dexmedetomidine on peripheral nerve blocks, to date there is limited knowledge available on the impact of dexmedetomidine adjunct to levobupivacaine in axillary brachial plexus block. OBJECTIVE: In this study, we aimed to investigate the effects of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. METHODS: A total of 64 patients of American Society of Anesthesiologists physical status I/II scheduled to undergo forearm and hand surgery, in which an axillary block was used, were enrolled. The patients were randomly divided into 2 groups: in group L patients (n = 32), an axillary block was performed with 39 mL levobupivacaine 5% plus 1 mL of isotonic sodium chloride. In group D patients (n = 32), an axillary block was performed with 39 mL levobupivacaine 5% and 1 mL dexmedetomidine 1 mu g/kg(-1) plus isotonic sodium chloride. Demographic data, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Spo(2)), sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, intraoperative verbal analog scale, postoperative visual analog scale (VAS) data, and side effects were recorded for each patient. RESULTS: There were no significant differences in patient and surgery characteristics between the 2 groups. Sensory block onset time was shorter in group D (P < 0.05). Sensory and motor block duration and time to first analgesic use were significantly longer in group D (P < 0.05), and the total need for analgesics was lower in group D (P < 0.05). Intraoperative 5- and 10-minute verbal analog scale values and postoperative VAS value at 12 hours were significantly lower in group D (P < 0.05). Intraoperative MAP and HR values, except at 5 minutes and postoperatively at 10 and 30 minutes and 1 and 2 hours, were significantly lower in group D (P < 0.01). Bradycardia, hypotension, hypoxemia, nausea, vomiting, and any other side effects were not seen in any patients. CONCLUSIONS: It was concluded in our study that adding dexmedetomidine to axillary brachial plexus block shortens sensory block onset time, increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side effects. ClinicalTrials.gov identifier ISRCTN67622282. (Curr Ther Res Clin Exp. 2012;73:103-111) (C) 2012 Elsevier HS Journals, Inc. All rights reserved.
Effects of alpha 2-adrenoceptor agonists dexmedetomidine and guanfacine on morphine analgesia and tolerance in rats
(TAYLOR & FRANCIS LTD, 2011) Gursoy, Sinan; Ozdemir, Ercan; Bagcivan, Ihsan; Altun, Ahmet; Durmus, Nedim
Background. Alpha 2 (alpha(2))-adrenoceptor agonists may be useful for their potential to increase or prolong opioid analgesia while attenuating the development of opioid tolerance. The purpose of this study was to investigate the effects of dexmedetomidine and guanfacine (alpha(2)-adrenoceptor agonists) on morphine analgesia and tolerance in rats. Methods. Adult male Wistar albino rats weighing 195-205 g were used. To constitute morphine tolerance, animals received morphine (50 mg/kg) once daily for 3 days. After the last dose of morphine had been injected on day 4, morphine tolerance was evaluated by analgesia tests. The analgesic effects of dexmedetomidine (20 mg/kg), guanfacine (0.5 mg/kg), MK-467 (0.25 mg/kg), and morphine were estimated at 30-min intervals (0, 30, 60, 90, and 120 min) by tail-flick and hot-plate analgesia tests. Results. Our findings indicate that dexmedetomidine and guanfacine attenuated the expression of morphine tolerance. In addition, administration of dexmedetomidine with morphine increased morphine analgesia. On the contrary, data suggested that MK-467 (an alpha(2)-adrenoceptor antagonist) decreased morphine analgesia and increased morphine tolerance in analgesia tests. Conclusion. In conclusion, we observed that co-injection of dexmedetomidine or guanfacine with morphine attenuated the expression of tolerance to the analgesic effect of morphine and that dexmedetomidine enhanced the morphine analgesia.
The effects of different doses of remifentanil on intraocular pressure after tracheal intubation: A randomized, double-blind and prospective study
(AMER SOC CONTEMPORARY MEDICINE SURGERY & OPHTHALMOLOGY, 2007) Kaygusuz, Kenan; Toker, M. Ilker; Kol, Iclal Ozdemir; Erdogan, Haydar; Gursoy, Sinan; Mimaroglu, Caner
We investigated the effects of alfentanil and different doses of remifentanil on intraocular pressure (IOP) and hemodynamic responses during laryngoscopy and endotracheal intubation in 60 patients. IOP values decreased significantly from 30 seconds before the intubation to 5 minutes after intubation measurements compared to baseline values in all the groups. However, a significant increase in 1OP was recorded in the 0.5-mu g remifentanil group after tracheal intubation.
The effects of endocannabinoid receptor agonist anandamide and antagonist rimonabant on opioid analgesia and tolerance in rats
(GENERAL PHYSIOL AND BIOPHYSICS, 2015) Altun, Ahmet; Ozdemir, Ercan; Yildirim, Kemal; Gursoy, Sinan; Durmus, Nedim; Bagcivan, Ihsan
The role of the cannabinoid (CB) system in the tolerance to analgesic effect of opioid remains obscure. The aim of the present study was to evaluate the effects of the endocannabinoid nonselective receptor agonist anandamide (AEA) and CB1 receptor antagonist rimonabant (SR141716) on morphine analgesia and tolerance in rats. Male Wistar albino rats weighing 215-230 g were used in these experiments. To constitute morphine analgesic tolerance, a 3-day cumulative dosing regimen was used. The analgesic effects of AEA (10 mg/kg), SR141716 (10 mg/kg), and morphine (5 mg/kg) were considered at 30-min intervals by tail flick (TF) and hot plate (HP) analgesia tests. The analgesic effects of the drugs were measured as TF and HP latencies in all groups for each rat and converted to %MPE. The data were analysed by analysis of variance followed by Tukey test. The findings suggested that AEA in combination with morphine produced a significant increase in expression of analgesic tolerance to morphine. Conversely, cannabinoid receptor antagonist SR141716 attenuated morphine analgesic tolerance. In addition, administration of AEA with morphine increased morphine analgesia. In conclusion, we observed that the cannabinoid receptor agonist anandamide and CB1 receptor antagonist SR141716 plays a significant role in the opioid analgesia and tolerance.
Effects of extremely low frequency electromagnetic fields on morphine analgesia and tolerance in rats
(GENERAL PHYSIOL AND BIOPHYSICS, 2017) Ozdemir, Ercan; Demirkazik, Ayse; Gursoy, Sinan; Taskiran, Ahmet S.; Kilinc, Olca; Arslan, Gokhan
Several studies have demonstrated that the electromagnetic fields produce analgesic activity. The aim of this study was to investigate the effects of extremely low frequency (ELF) electromagnetic fields (EMF) on morphine analgesia and tolerance in rats. In the study, 78 adult male Wistar albino rats (approximately 240 +/- 12 g) were used. The application of 50 Hz magnetic field, each day the same times for 30 minutes for 15 days, and a total of four times every 15 minute intervals. To constitute morphine tolerance, high dose of morphine (50 mg/kg) were administered for 3 days in rats and tolerance was evaluated on day 4. Prior to analgesia tests, the effective dose (5 mg/kg) of morphine was injected into rats. In the statistical analyzes of the data, analysis of variance (two-way ANOVA) was used and the multiple comparison determined by Tukey tests. The maximum analgesic effect of the 5 mT magnetic field was determined on 7 days. Administration of morphine (5 mg/ kg) in rats exposed to a magnetic field, the analgesic effect was significantly higher compared to the morphine group (p < 0.05). Morphine tolerant animals exposed to a magnetic field, the analgesic effect was found significantly higher than morphine tolerant group rats (p < 0.05). Analgesia test data demonstrated that application of ELF-EMFs to rats increases the morphine analgesia and reduces morphine tolerance.
Effects of facet joint nerve block addition to radiofrequency in the treatment of low back pain
(DRUNPP-SARAJEVO, 2012) Duger, Cevdet; Kol, Iclal Ozdemir; Kaygusuz, Kenan; Gursoy, Sinan; Mimaroglu, Caner
Objective: We aimed to compare the effects of radiofrequency, local anesthetic and steroid injection and combination of them for facet syndrome that is a reason of low back pain. Summary of Background Data: Basically, radiofrequency thermocoagulation is a procedure that causes tissue damage like nerves by exposing the tissue to heated electrode tip. Nerve blocking has been used as an effective pain therapy method. So we tried to compare and combine these two methods in the treatment of lumbar facet syndrome. Methods: Patients were randomly divided into 3 groups (n=40) each consisted of 40 individuals. Local anesthesia was applied after determining the injection area by c-arm scope device. Radiofrequency was applied in Group R, a mixture of 20 mg metilprednisolone and 5 mg bupivacain was administered in Group B and combination of all these was applied in Group RB. VAS, activity and satisfaction scores were recorded before and after the procedure. Results: In Group R and Group RB, VAS and activity scores were similar except day 1, day 2 and week 1 and better than group B. Satisfaction scores of Group B were lower when compared to Group R and RB. However, satisfaction scores of Group RB were higher than those of Group R in day 1, day 2 and week 1 but there was no difference at later time points. Conclusion: In conclusion, we suggest that successful results can be obtained with radiofrequency thermocoagulation plus facet nerve block combination therapy in patients having lumbar facet syndrome.
Effects of intravenous anesthetics on the human radial artery used as a coronary artery bypass graft
(W B SAUNDERS CO-ELSEVIER INC, 2007) Gursoy, Sinan; Berkan, Ocal; Bagcivan, Ihsan; Kaya, Tijen; Yildirim, Kemal; Mimaroglu, Caner
Objective: Intravenous anesthetics are often used for anesthesia, sedation, and analgesia in the intraoperative and postoperative periods of coronary artery bypass graft (CABG) surgery. This study was designed to investigate the direct effects of intravenous anesthetics on the human radial artery (RA). Design: In vitro, prospective with repeated measures. Setting: University research laboratory. Participants: RA segments (n = 20) were obtained from CABG surgery patients and were divided into 3- to 4-mm vascular rings. Interventions: Using the organ bath technique, the endothelium-independent vasodilatation function was tested in vitro by the addition of cumulative concentrations of thiopental, ketamine, etomidate, and propofol after vasocontraction by phenylephrine in the presence of NG-nitro-L-arginine methyl ester (L-NAME) and indomethacin. Measurements and Main Results: Thiopental (10(-8) to 10(-4) mol/L), ketamine(10(-8) to 10(-4) mol/L), propofol (10(-8) to 3 x 10-(4) mol/L), and etomidate (10(-8) to 3 x 10(-4) mol/L) caused concentration-dependent vasorelaxation in human RA rings precontracted with phenylephrine in the presence of L-NAME and indomethacin (n = 20, for each drug). The pEC(50) and maximum relaxant effect values of thiopental and ketamine were significantly higher than for etomidate and propofol (p < 0.05). Conclusions: These findings indicate that thiopental, ketamine, etomidate, and propofol produce concentration-dependent relaxation on RA rings from humans. Thiopental and ketamine are more potent relaxant agents than etomidate and propofol. Intravenous anesthetics may be effective as alternative vasodilators for treatment of intraoperative and postoperative spasm of coronary artery grafts. (c) 2007 Elsevier Inc. All rights reserved

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