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Öğe 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, CanerBackground 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.Öğe 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, CanerThis 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.Öğe Aspiration and Death from Amitraz-Xylene Poisoning(Medi+World Int, 2006) Beyaztas, Fatma Yucel; Gursoy, Sinan; Demirel, Yeltekin; Kaygusuz, Kenan; Mimaroglu, CanerAmitraz 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.Öğe 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, YenerBACKGROUND: 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.Öğe 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, CanerObjective: 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, BaselÖğe 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, CanerBACKGROUND: 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.Öğe 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, CanerAim: 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.Öğe 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, SinanObjectives: 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.Öğe 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, CanerBACKGROUND: 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.Öğe 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, CanerWe 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.Öğe 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, CanerObjective: 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.Öğe 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, CanerObjective: 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 reservedÖğe The Effects of Intravenous Ephedrine During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled Trial(KOREAN ACAD MEDICAL SCIENCES, 2009) Kol, Iclal Ozdemir; Kaygusuz, Kenan; Gursoy, Sinan; Cetin, Ali; Kahramanoglu, Zeki; Ozkan, Fikret; Mimaroglu, CanerWe designed a randomized, double-blinded study to determine the efficacy and safety of 0.5 mg/kg intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Patients were randomly allocated into two groups: ephedrine group (n=21) and control group (n=21). Intravenous preload of 15 mL/kg lactated Ringer's solution was given. Shortly after the spinal injection, ephedrine 0.5 mg/kg or saline was injected intravenous for 60 sec. The mean of highest and lowest heart rate in the ephedrine group was higher than those of control group (P<0.05). There were significant lower incidences of hypotension and nausea and vomiting in the ephedrine group compared with the control group (8 [38.1%] vs. 18 [85.7%]); (4 [19%] vs. 12 [57.1%], respectively) (P<0.05). The first rescue ephedrine time in the ephedrine group was significantly longer (14.9 +/- 7.1 min vs. 7.9 +/- 5.4 min) than that of the control group (P<0.05). Neonatal outcome were similar between the study groups. These findings suggest, the prophylactic bolus dose of 0.5 mg/kg intravenous ephedrine given at the time of intrathecal block after a crystalloid fluid preload, plus rescue boluses reduce the incidence of hypotension.Öğe The evaluation of radiofrequency facet nerve denervation in the patients with lumbar facet syndrome: experience with 493 patients(ANAESTHESIA PAIN & INTENSIVE CARE, 2017) Mimaroglu, Caner; Mimaroglu Altinay, Beste; Duger, Cevdet; Isbir, Ahmet Cemil; Gursoy, Sinan; Kaygusuz, Kenan; Kol, Iclal OzdemirObjective: Radio frequency thermocoagulation (RFT) is a relatively new modality and has been recommended for treatment of back pain diagnosed as to be originating from spinal facet joints. We aimed to evaluate the efficacy of this novel procedure in our patients with lumbar facet syndrome in our department of algology. Methodology: In this retrospective, observational study, the medical records of 493 lumbar facet syndrome patients treated using RFT in 2008-2013, were reviewed. All data were obtained from the pain evaluation cards in the patient files and recorded. Data of age, sex, visual analog scale (VAS) scores before and after the therapy and satisfaction scores after the therapy were recorded from medical records of the patients. Visual analogue scale (VAS) pain scores, daily activities (1 = poor to 4 = very good) and satisfaction scores (1 = poor to 4 = excellent) before the procedure and at the day 1, day 2, and then at one week, 2 weeks, one month, 6 months and 12 months following the procedure, were reviewed and recorded. Results: Mean VAS score before the therapy was 8.03 +/- 1.06, one month after the therapy it was significantly reduced and 6 months after the therapy it was found as 2.18 +/- 0.76. The satisfaction scores were found significantly higher after therapy. Data of movement scores were found higher after the therapy than the scores before therapy. No complication was noted in any of the patient. Conclusion: We conclude that radio frequency thermocoagulation (RFT) can lead to significant long-term improvement in low back pain, and it can improve the physical function ability to a greater extent in patients with facet pain syndrome.Öğe The Importance of Needle Echogenity in Ultrasound Guided Axillary Brachial Plexus Block: A Randomized Controlled Clinical Study(IVYSPRING INT PUBL, 2013) Duger, Cevdet; Isbir, Ahmet Cemil; Kaygusuz, Kenan; Kol, Iclal Ozdemir; Gursoy, Sinan; Ozturk, Hayati; Mimaroglu, CanerObjective: In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery. Methods: 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided axillary block using non-echogenic needle with nerve stimulator assistance. Duration of block procedure, mean arterial pressure, heart rate, pulse-oximetry, onset time of sensory and motor block, duration of sensory and motor block, time to first analgesic use, total need for analgesics, postoperative pain scores, patient and surgeon satisfaction scores were recorded. Results: Duration of block procedure values were lower in group E and NS, sensory and motor block durations, were significantly lower in group N. Sensorial and motor block onset time values were found lower in group NS but higher in group N. Patient and surgeon satisfaction scores were found lower in group N. Conclusion: We conclude that ultrasound guided axillary block may be performed successfully using both echogenic needles and nerve stimulation assisted non-echogenic needles.Öğe Ineffective Doses of Dexmedetomidine Potentiates the Antinociception Induced by Morphine and Fentanyl in Acute Pain Model(KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY, 2013) Unal, Mumin; Gursoy, Sinan; Altun, Ahmet; Duger, Cevdet; Kol, Iclal Ozdemir; Kaygusuz, Kenan; Bagcivan, Ihsan; Mimaroglu, CanerThe aim of this study was to evaluate the synergistic potentiation effect of ineffective doses of dexmedetomidine on antinociception induced by morphine and fentanyl in acute pain model in rats. Seventy albino Wistar rats were separated into 7 groups. Data for the control and sham groups were recorded. The ineffective dose of dexmedetomidine was investigated and found to be 3 mu g/kg. Each group was administered the following medications: 3 mg/kg morphine (intraperitoneal) to Group 3, 5 mu g/kg fentanyl (intraperitoneal) to Group 4, dexmedetomidine 3 mu g/kg (subcutaneously) to Group 5, dexmedetomidine 3 mu g/kg (subcutaneous)+3 mg/kg morphine (intraperitoneal) to Group 6 and finally 3 mu g/kg dexmedetomidine (subcutaneous)+5 mu g/kg fentanyl (intraperitoneal) to Group 7. Just before the application and 15, 30, 60, 90 and 120 min after the administration of medication, two measurements of tail flick (TF) and hot plate (HP) tests were performed. The averages of the measurements were recorded. TF and HP latencies were the main outcomes. The analgesic effect of the combinations with dexmedetomidine+morphine (Group 6) and dexmedetomidine+fentanyl (Group 7), compared to the analgesic effect of morphine alone and fentanyl alone was significantly higher at 15, 30, 60 and 90 minutes after administration. In this study, dexmedetomidine in ineffective doses, when combined with morphine and fentanyl, potentiates the effects of both morphine and fentanyl.Öğe Investigation of the Cardiac Effects of Pancuronium, Rocuronium, Vecuronium, and Mivacurium on the Isolated Rat Atrium(ELSEVIER SCIENCE INC, 2011) Gursoy, Sinan; Bagcivan, Ihsan; Durmus, Nedim; Kaygusuz, Kenan; Kol, Iclal Ozdemir; Duger, Cevdet; Yildirim, Sahin; Mimaroglu, CanerBACKGROUND: Pancuronium, vecuronium, rocuronium, and mivacurium are nondepolarizing neuromuscular blocking agents that affect the cardiovascular system with different potencies. Their cardiovascular effects are clinically significant in the anesthetic management of patients, particularly those undergoing cardiac surgery. OBJECTIVE: We aimed to compare the cardiac effects of these compounds, such as heart rate and developed force, in one species under identical experimental conditions in isolated rat atria. METHODS: The left or right atria of rats were removed and suspended in organ baths. Pancuronium, vecuronium, rocuronium, or mivacurium were added cumulatively (10(-9)-10(-5) M) in the presence and absence of the nonselective beta-blocker propranolol (10(-8) M) and the noradrenaline reuptake inhibitor desipramine (10(-7) M), and heart rate changes were recorded in spontaneously beating right atria. Left atrial preparations were stimulated by electrical field stimulation using a bipolar platinum electrode, and the effects of cumulative concentrations of these nondepolarizing neuromuscular blocking agents on the developed force in the presence and absence of propranolol (10(-8) M) and desipramine (10(-7) M) were recorded. RESULTS: Pancuronium increased heart rate in a dose-dependent manner compared with the control group (P < 0.027). Vecuronium, rocuronium, and mivacurium also increased heart rate in a dose-dependent manner, but the changes were not statistically significant. Although propranolol decreased the pancuronium heart rate effect (P < 0.05), it did not change the heart rate effects with vecuronium, rocuronium, or mivacurium. Desipramine did not change the heart rate effects of vecuronium, rocuronium, mivacurium, or pancuronium. All 4 drugs increased developed force in a dose-dependent manner; the increases were significant at 10(-5) M concentration for pancuronium and at 10(-6) and 10(-5) M concentrations for vecuronium, rocuronium, and mivacurium (P < 0.038). These increases in developed force were abolished with the addition of propranolol. Desipramine did not change the developed force effects of any of the 4 drugs. CONCLUSIONS: The heart rate effect of pancuronium and developed force effects of pancuronium, vecuronium, rocuronium, and mivacurium may occur via direct stimulation of p receptors. Although our investigation was an in vitro study, the effects found may be important especially under pathologic conditions, such as hypertension, in which patients usually use beta-blocking agents, which cause beta receptor upregulation. (Curr Ther Res Clin Exp. 2011;72:195-203) (C) 2011 Elsevier HS Journals, Inc. All rights reserved.Öğe Investigation of the relaxant effects of pancuronium, rocuronium, vecuronium and mivacurium on rat thoracic aorta(LIPPINCOTT WILLIAMS & WILKINS, 2009) Gursoy, Sinan; Bagcivan, Ihsan; Durmus, Nedim; Kaygusuz, Kenan; Kol, Iclal Ozdemir; Yildirim, Sahin; Mimaroglu, CanerBackground and objective Pancuronium, vecuronium, mivacurium and rocuronium are nondepolarizing neuromuscular blocking agents, which are competitive antagonists against acetylcholine at nicotinic receptors, and considered to have no direct actions on vascular smooth muscle. We aimed to investigate the relaxant effects and possible underlying mechanisms of these agents on isolated rat thoracic aorta. Methods The preparations were precontracted with prostaglandin F2 alpha (10(-7) mol l(-1)) and pancuronium (10(-7)-10(-4) mol l(-1)'), rocuronium (10(-7)-10(-4) mol l(-1)), vecuronium (10(-1)-10(-4) mol l(-1)) and rnivacurium (10(-7)-10(-4) mol l(-1)) added at cumulative concentrations in the presence or absence of a prostaglandin synthesis inhibitor, indomethacin (10- 6 M), and a nitric oxide synthesis inhibitor, N(omega)-nitro-L-arginine methylester (3 X 10-5). The same protocol was applied to both endothelia (+) and endothelia (-) aortic rings. The preparations precontracted with prostaglandin F2 alpha (10(-7) mol l(-1)) were stimulated with electrical field stimulation at a frequency of 10 Hz as squarewave pulses of 50 V (0.2 ms) in the presence of a noradrenaline reuptake inhibitor desipramine (10(-7) mol l(-1)) and a nonselective beta-blocker propranolol (10(-6) mol l(-1)). Drugs were added at ineffective concentration of 10(-7) mol l(-1). Tetrodotoxin (10(-7) mol l(-1)) was added to test whether the changes were dependent on the neuronal response. Results Pancuronium and rocuronium relaxed aortic rings precontracted by prostaglandin F2 alpha in a dose-dependent manner, but vecuronium and mivacurium did not. The relaxation effect of pancuronium and rocuronium was endothelium independent because there was nota significant response difference from the endothelium-denuded group. Conclusion In conclusion, their relaxation effect may be due to an increase in prostaglandin synthesis. The increased relaxation effect of these agents at electrical field stimulation may be by the decreasing effect of noradrenaline reuptake from nerve endings because a noradrenaline reuptake inhibitor desipramine did not change this effect Also, these neuromuscular agents may affect beta-receptors, because a nonselective beta-blocker agent, propranolol, decreased their electrical field stimulation-induced relaxations. Eur J Anaesthesiol 26:155159 (c) 2009 European Society of Anaesthesiology.Öğe Levothyroxine intoxication: Scientific letter(ORTADOGU AD PRES & PUBL CO, 2007) Kol, Iclal Oezdemir; Guerelik, Bilge; Kaygusuz, Kenan; Guersoy, Sinan; Goenuellue, Mustafa; Mimaroglu, CanerLevothyroxine is presently dominant agent prescribed for thyroid hormone replacement; it account for 75% of all prescriptions for thyroid hormone products. Intoxication of levothyroxine might be associated with thyrotoxicose or it might causes mild clinical symptoms as well. In this study, we presented (18-years old) a case report of levothyroxine intoxication which was treated in the intensive care unit. in the management, gastric lavage, activated charcoal prophylthiouracil, propranolol, and prednisolon were administered. The patient was discharge without any symptoms of thyrotoxicose or any other complications. This case report presents appropriate management of levothyroxine intoxication.Öğe Open-label, prospective, randomized comparison of propofol and sevoflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients(ELSEVIER, 2008) Kol, Iclal Ozdemir; Egilmez, Hulusi; Kaygusuz, Kenan; Gursoy, Sinan; Mimaroglu, CanerBackground: Magnetic resonance imaging (MRI) for pediatric patients often requires deep sedation or anesthesia because they must remain completely immobile for a relatively long period to obtain high-quality images. Objective: The aim of this study was to compare the effectiveness of propofol IV or inhalation of sevoflurane anesthesia with the laryngeal mask airway (LMA) for children undergoing MRI. Methods: Children aged 2 to 6 years with American Society of Anesthesiologists' physical status of I to 11 who were scheduled for MRI were enrolled in this study and randomly divided into 2 groups. The propofol group was administered propofol 4 mg/kg IV followed by infusion of 150 mu g/kg . min(-1). Patients in the sevoflurane group were induced with sevoflurane 8% by face mask and maintained with an air/oxygen mixture followed by sevoflurane 1.5%. Data recorded included age, weight, scan time, LMA insertion, removal, and recovery times, hemodynamic parameters, complications, pediatric anesthesia emergence delirium (PAED) scale score, child movement, and MRI interruption. A higher PAED score indicated a higher level of delirium. Results: Eighty-eight children were enrolled and randomized to treatment. Nine children were excluded from analysis due to protocol violations. After completion of the study, there were 37 children in the propofol group (male/female, 18/19; mean [SDI age, 42.1 months; weight, 15.2 [4.9] kg; scan time, 20.5 [4.6] min) and 42 in the sevoflurane group (male/ female, 15/27; mean [SDI age, 44.4 [26.1] months; weight, 15.1 [5.2] kg; scan time, 20.6 [4.8] min). No significant differences were found between the study groups with regard to age, weight, scan time, and hemodynamic parameters at baseline and during the study period. Mean LMA insertion, removal, and recovery times were significantly longer in the propofol group (4.8, 5.2, and 8.8 minutes, respectively) than in the sevoflurane group (3.3, 2.5, and 3.9 minutes, respectively) (P < 0.05). The mean PAED score in the propofol group was significantly lower than that in the sevoflurane group (mean [SDI, 6.1 [4.0] vs 10.5 [3.7]; P < 0.05). The percentage of MRI interruption in the propofol group was significantly higher than that in the sevoflurane group (4 [11%] vs 0, respectively; P < 0.05). No episodes of hypotension or bradycardia occurred during the study, and alterations in the propofol infusion rate or sevoflurane concentration were not necessary. One child vomited in the sevoflurane group during the postoperative period. Conclusions: This small study found that sevoflurane, at the doses used in this study, provided shorter induction and faster recovery times than IV propofol for LMA anesthesia in these selected children undergoing MRI. The percentage of MRI interruption in the propofol group was significantly higher than that in the sevoflurane group. Sevoflurane was associated with a significantly higher score on the PAED scale, indicating greater emergence delirium.
