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Öğe Can combined spinal-epidural analgesia be an alternative to epidural analgesia alone in labour?(2003) Ölmez G.; Da? I.H.; Özyilmaz M.A.; Yalinkaya A.Currently, the final point in labour analgesia has been accepted as combined spinal-epidural analgesia (CSE). In this prospective and randomised study, we aimed to investigate whether this approach can be an alternative to epidural analgesia (EA) as a reference method. The study was performed with 50 primigravid pregnant women who planned to have vaginal delivery. The patients were allocated randomly to one of the two groups: In Group I, CSE block was applied in 25 patients and epidural block in Group II with 25 patients. A solution of 0.125% bupivacaine with 2 ?g mL-1 fentanyl was prepared for using in patient controlled epidural analgesia (PCEA). Epidural catheters were introduced following the spinal administration of bupivacain (2.5 mg) plus fentanyl (25 ?g) in patients in Group1. PCEA was started after the VAS scores exceeded the level of 3. In Group 11, PCEA was started shortly after introducing of epidural catheters. Only with the first subarachnoidal dosage in GI sufficient analgesia was obtained in all patient. Duration of spinal analgesia was 89.80±9.94 min. At the fifth minute, VAS pain scores were significantly lower in CSE group than in EA group (p<0.0001). The amount of total bupivacaine consumption was 47.96±11.42 mg in GI and was 69.72±11.54 mg in GII (p<0.0001). These amounts for fentanyl consumption was 97.21±18.76 ?g in GI and 111.52±18.50 ?g in GII (p<0.05). There were no significant differences in the other variables. We conclude that CSEA technique can be an alternative approach in conditions of required fast analgesia and short term labour action in delayed deliveries and in multipartaous pregnants.Öğe Can ropivacaine be preferred for epidural anesthesia for Turp operations?(2006) Aydin N.; Ölmez G.; Özyilmaz M.A.Objective: Epidural anesthesia is preferred in endoscopic urological procedures as it decreases the incidence of surgical bleeding and venous thrombosis and provides early diagnosis of complications such as bladder rupture and TURP syndrome. The aim of this study is to compare ropivacaine and bupivacaine in epidural anesthesia for cases to undergo TURP surgery. Method: Forty eight ASA I-III male patients aged 45-85 with benign prostate hypertrophy undergoing transurethral resection were included in this study. In Group I, 20 ml of ropivacaine 0.5 %, in Group II 20 ml of bupivacaine 0.5 % were administered by epidurally. Hemodynamic parameters, patients' comfort, anesthetic properties and side effects were compared. Results: In Group I, time it took for the anesthesia level to reach T10, two-segment regression time and regression time to T12 were found to be faster than in Group II (p=0.024, p=0.006, p=0.004). Motor blockade was more intense in Group II than in Group I. Efficient anesthesia and analgesia were obtained in both groups. There was no difference in terms of side effects and quality of blockade between the groups. The most commonly encountered side effects were hypotension, and bradycardia in both groups. Conclusion: We can say that both medications are safe and effective in TURP surgery. However, ropivacaine has faster sensorial block, dissipates more rapidly and has less motor block density bupivacaine.Öğe A comparison of the effects of ondansetron with or without dimenhydrinate in the prevention of nausea and vomiting after major gynaecological surgery(1999) Turhanoğlu S.; Özyilmaz M.A.; Tok D.; Ölmez G.; Ş Çinar F.; Bayhan N.The aim of this study was to compare the efficacy and safety of ondansetron plus dimenhydrinate with ondansetron or dimenhydrinate alone and control groups in prevention of postoperative nausea and vomiting (PONV). We studied 100 ASA I-II females undergoing general anaesthesia for major gynaecological surgery. Patients were allocated randomly to one of four groups and administered ondansetron 4 mg i.v. to groups I and II immediately prior to the induction of anaesthesia and dimenhydrinate 50 mg i.m. to groups II and III about 30 minutes before operation. The patients of group IV were administered 0.9% saline as placebo and were accepted as a control group. A standardized anaesthetic tecnique and postoperative analgesia were used in all patients. The incidence of nausea in the ondasetron with dimenhydrinate group was lower than in the other groups (p < 0.05). The incidence of vomiting in the ondansetron with dimenhydrinate group was significantly lower at the first six hours of the postoperative period than in the control group (p < 0.05). Sedation was significantly greater with dimenhydrinate groups for the first hour of the postoperative period (p < 0.05). We conclude that prophylactic administration of combined ondansetron and dimenhydrinate is more effective in preventing PONV than ondansetron or dimenhydrinate alone and control groups in women undergoing major gynaecological surgery.Öğe Effects of concentration and volume of ropivacaine in epidural anesthesia(2004) Tekeli T.; Ölmez G.; Özyilmaz M.A.Effect of local anesthetic concentration and volume on the epidural anesthetic properties is unclear. This study was performed to determine effects of a therefold difference in concentration and volume ropivacaine on epidural anesthesia. Sixty adult patients, ASA I-II, scheduled for lower limb surgery were included in this prospective, double blind study. Patients were randomly divided into three group with 20 in each. Group I received 1% ropivacaine in 10 mL volume (100 mg), Group II 0.5% ropivacaine in 10 mL volume (100 mg); and Group III 0.75% ropivacaine in 20 mL volume (150 mg) via epidural route. The groups compared with local anaesthetic properties, hemodinamic effects and adverse effects. Sensory anesthesia was adequate for surgery in all of the patients. The onset of sensorial analgesia at the T10 dermatome in groups III was faster than Group II (p<0.05). Times to regression of anesthesia to T10 and T12 dermatoma increased in Group III. These changes were not statistically significant. The degree of motor blockade at 20 min and 120 min by using the Bromage scale was higher than the other group (p<0.001). Cardiovascular changes were similar in all three groups. Finally; intensity of sensory and motor block from epidural anesthesia with ropivacaine appears to depend primarily on total milligram dose and ropivacaine 0.75% in a volume of 20 mL proved to be a very potent local anesthetic with moderate motor blockade.Öğe Effects of ropivacaine volumes in axillary brachial plexus block(2005) Ölmez G.; Özyilmaz M.A.; Kaya Z.; Tekeli T.Aim: Increasing local anaesthetic volume may provide greater distribution of the drug within the brachial perivascular sheath. This study was performed to determine the effect of different volumes of ropivacaine in brachial plexus anaesthesia. Materials and Methods: After obtaining ethics committee approval, 40 ASA I-II patients receving axillary blocks were randomised into 2 groups. Group I received 20 mL 1 % ropivacaine and Group II received, 20 mL 1 % ropivacaine diluted with normal saline to a total volume of 40 mL. Time to onset of sensory and motor block, resolution of motor block, and onset of postoperative pain and the quality of block were recorded. Results: Times to onset of sensory and motor block, resolution of motor block and onset of postoperative pain were similar in two groups (p>0.05). Surgical anaesthesia was unsatisfactory in 6 patients in Group I and in 4 patients in Group II. requiring local supplementation by the surgen. Conclusion: We conclude, that there is no difference in the effect of anaesthetic and analgesic properties for axillary plexus block when 200 mg of ropivacaine is diluted to a total volume of 20 or 40 mL.Öğe Endotracheal intubation without the use of muscle relaxants: Comparisons three different remifentanil bolus doses following propofol induction(2004) Cengiz M.; Ganida?li S.; Ölmez G.Endotracheal intubation without neuromuscular blockade has been performed using several doses of propofol and remifentanil. In this study we investigated the effects of three different doses of remifentanil on endotracheal intubation following propofol induction. Forty-five healthy patients were randomly assigned to one of three equal groups. After intravenous bolus doses of propofol 2.5 mg kg-1, Group I, II and III received intravenous remifentanil 0.5 mg kg-1, 1 mg kg-1 and 2 mg kg-1 respectively. Remifentanil was injected in 30 seconds. Laryngoscopy and intubation was performed sixty seconds after remifentanil injection. Intubation conditions were assessed on the basis of the case of ventilation, jaw relaxation, position of vocal cords, and patients'response to intubation and inflation of endotracheal tube cuff. Hemodynamic responses to intubation were also recorded. Total intubation quality scores in Group III were higher than those of Group I and II (p<0.05). Mean arterial pressures after anaesthesia induction were lower than the control values in all groups (p<0.05). In Group I and Group II; heart rates after intubation were found to be significantly higher when compared with the pre-induction values (p<0.05). Heart rates in Group III were significantly lower at after induction periods when compared with the pre-induction values (p<0.05). It is concluded that; bolus of remifentanil 2 ?g kg-1 after propofol induction provides better intubation conditions without the use of muscle relaxants.Öğe Facet joint injection in patients with lumbar facet syndrome unresponsive to medical therapy(2000) Turhano?lu A.D.; Turhano?lu S.; Nazaro?lu H.; Karabulut Z.; Ölmez G.; Erdo?an F.Twenty seven patients who had been diagnosed as facet syndrome with clinical signs and computed tomography were included in the study. All patients received medical therapy for two weeks and patients allocated into two groups as benefit from medical therapy or not. Local anesthetic injections into facet joints were applied to 15 patients unresponsive to medical therapy. Facet joint injections were performed under fluoroscopy in two levels as degenerated segment and upper of this segment and metil prednisolone 10 mg (0.5 ml) and bupivacaine 10 mg 82 ml) were injected to each segment. All patients were controlled before therapy and 1 week, 1 month and 3 months later of therapy and evaluated as Visual Analoque Scale, Modify Schoeber test and Roland and Morris Scale and results were recorded. All of patients except one have been improved by facet joint injections, we concluded that lumbar facet joint injection could be a useful diagnostic and therapeutic procedure in the lumbar facet syndrome if patient selection made carefully.Öğe Obstructive atelectasis after nasotracheal intubation (case report)(2004) Ölmez G.; Özyilmaz M.A.; Karaman H.; Atay Ç.Severe intraoperative hypoxemia occurred in a healthy 18-yr-old accident victim scheduled to undergo operation because of maxillofacial trauma. Almost complete atelectasia was noticed in X-ray in the left lung. Fiberoptic bronchoscopy revealed a blood clot in the left main bronchus. Hypoxia and atelectasia improved immediately after removal of the blood clot. Obstruction due to clotted blood in the bronchus causing atelectasia after nasotracheal intubation should be kept in mind as a cause of intraoperative hypoxemia.Öğe Pathological changes related with nasotracheal intubation(2005) Ölmez G.; Özyilmaz M.A.; Yildirim M.Nasotracheal intubation offers better view and surgical area in head, neck and maxillofacial surgery. However, widespread use of this technique is restricted by concerns on the risk of damage. In this prospective and double-blinded study, nasotracheal intubation was performed in 45 adult patients who underwent maxillofacial surgery. The incidence of nasal damage and hemorrhage were investigated. There was no nasal damage or severe hemorrhage in any patient. There was no correlation between nasal injury and duration of intubation. Bleeding frequency was raised by intubation attend frequency but there was no relation between intubation attend frequency and mucosal injury. Results of this study suggest that performing nasal preparation and the use of a soft tube reduces the incidence of hemorrhage and mucosal damage.Öğe Preemptive lornoxicam for postoperative pain relief in patients undergoing lumbar disk surgery(2005) Özyilmaz M.A.; Ölmez G.; Gizdaş Uluç D.Lornoxicam is a relatively new and non opioid analgesic belonging to the oxicam group. The aim of this study to investigate preemptive analgesic effect of lornoxicam. This study was carried out in a prospective, randomized, double-blind fashion with 60 patients (ASA I or II) undergoing lumbar mikrosurgical discectomy. They were divided into three groups. Group-I (n=20, preemptive group) patients received IV lornoxicam (8 mg) before surgery, Group-II (n=20, intraoperative group) patients received IV 2 mL saline solution before surgery and 8 mg IV lornoxicam before skin closure and Group-III (n=20, control group) patients received IV 2 mL saline before surgery and before skin closure. Postoperative analgesia was maintained by patient controlled intravenous morphine. The visual analogue scale (VAS) was used to assess the pain level. The amount of morphine used by the patients and VAS were assessed at the 0, 15, 30, 45, 60th minutes and the 2, 4, 6, 12, 24th hours postoperatively and the total morphine consumption was noted. Group-I demonstrated significantly reduced pain scores compared to Group-II and Group-III. The pain scores of Group-II were relatively lower than Group-III, but MTM and TMT are not statistically meaningful. We determined only nausea-vomiting as adverse effect for all groups. Nausea-vomiting incidences of Group-I and Group-II were meaning less than Group-III. In this study; lornoxicam administered preemptively appeared to improve the quality of postopertaive analgesia and led to reduced consumption of opioid analgesic postoperatively.
