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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 Comparison of Different Predictive Tests for Predicting Difficult Intubation(2003) Kararmaz A.; Turhano?lu S.; Kaya S.; Özyilmaz M.A.We aimed to determine optimum cut points of each predictive test to establish the optimum predictive level. By using these cut points, predictive tests were also compared with their ability to predict difficult intubation. The patients were assessed preoperatively with respect to the Mallampati classification, thiromental, sternomental and inter-incisor distances, and atlantooccipital joint extension. During laryngoscopy, the view of the glottis was graded according to Cormack and Lehane's classification. Receiver operating characteristics curve was used to determine optimum cut point and relationship between predictive tests and difficult intubation. Incidence of difficult intubation was determined as 4.7 %. No relationship was found between inter-incisor distance with difficult intubation. Cut points were established as 6.5 cm, 12 cm, and 250 for thiromental distance, sternomental distance and atlantooccipital joint extension, respectively. Generally predictive tests were associated with poor sensitivity and positive predictive value. The combination of the Mallampati classification with thiromental distance had highest positive predictive value (80 %), but this combination decreased the sensitivity. We conclude that these four tests are of little value in predicting difficult intubation, even if its optimum cut point is used.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 Effects of the Recruitment Manoeuvre on Arterial Oxygenation and Lung Compliance after Laparoscopy(2004) Kararmaz A.; Kaya S.; Turhano?lu S.; Özyilmaz M.A.The aim of this study was to determine the effect of recruitment manoeuvre on arterial oxygen partial pressure and lung compliance in patients undergoing laparoscopic cholecystectomy. Thirty-six patients who were scheduled for elective laparoscopic cholecystectomy were included to the study. Anaesthesia was induced with propofol, cisatracurium and fentanyl and maintained by sevoflurane 2-4% in 100% oxygen, cisatracurium and fentanil, if necessary. In Group R, after removal of carbondioxide from the peritoneal cavity, a recruitment manoeuvre was performed with a peak airway pressure of 40 cmH 2O and a PEEP of 20 cmH2O for 10 breaths. PEEP was then reduced and kept at 5 cmH2O. In Group K, only PEEP (5 cmH 2O) was applied. Airway pressures and compliance were recorded after induction of anaesthesia, after CO2 insufflation, after removal of the CO2 and after recruitment manoeuvre. There was a significant reduction in arterial oxygen partial pressure and lung compliance after abdominal carbondioxide insufflation in both two groups (p<0.001). In Group R, recruitment manoeuvre improved arterial oxygenation and lung compliance (p<0.01). There was a positive correlation between arterial oxygen partial pressure and lung compliance (r=0.525, p<0.01). No complication was observed throughout the study. We concluded that recruitment manoeuvre is an effective intervention to correct abnormalities in gas exchange after laparoscopic cholecystectomy.Öğe The Effects of the Type of Neuroaxial Block on Postoperative Pain after Total HIP Replacement Surgery: Spinal vs. Epidural Anaesthesia(2004) Kararmaz A.; Kaya S.; Karaman H.; Turhano?lu S.; Özyilmaz M.A.In this study, we aimed to investigate whether the type of anaesthesia affected postoperative pain, or not, when total hip replacement surgery was performed under spinal or epidural anaesthesia. The patients were randomly assigned to two groups. In Group E, surgery was performed under epidural anaesthesia, and in Group S under spinal anaesthesia. Patient controlled epidural analgesia with morphine and bupivacaine was used for postoperative analgesia. Visual analog scale was recorded at the rest and during movement. Postoperative analgesic consumption, patient satisfaction and complications were also recorded. Visual analog scale scores were significantly lower in Group S at the rest and during movement (p<0.05). Postoperative analgesic consumption was lower in Group S (p=0.001). There was no difference with regard to postoperative complications. The patients were more satisfied with their analgesic treatment in Group S (83%) than those of Group E (54%) (p=0.037). In conclusion, we observed that spinal anesthesia produced more satisfactory postoperative analgesia after total hip replacement surgery. We believe that this beneficial effect may be related to complete blockade of nociceptive afferent signals by the spinal anaesthesia.Öğe Effects of whole blood, crystalloid and colloid resuscitation of hemorrhagic shock on lung perfusion in rats(1999) Turhanoglu S.; Özyilmaz M.A.; Tok D.; Çobaner A.; Kaya S.; Bayhan N.This study was undertaken to determine the effects of various resuscitation regimens on lung perfusion following resuscitation from hemorrhagic shock. We used Spraque Dawley rats and measured blood pressure, rectal temperature and lung perfusion using radioscintigraphy with a technetium colloid indicator. Compared to a control group, lung perfusion was decreased significantly in groups resuscitated with saline, Ringer's lactate and hetastarch while perfusion was restored with autologous blood and dextran 40.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.Öğe Remifentanil and droperidol administration for monitored anaesthesia care(2002) Kararmaz A.; Kaya S.; Turhano?lu S.; Özyilmaz M.A.; Bayhan N.In this prospective randomised study, it was aimed to evaluate which dose of remifentanil applied via patient controlled analgesia (PCA) was proper for monitored anaesthesia care during extracorporeal shock wave lithotripsy in patients received droperidol as pretreatment [A1]. Droperidol (20 ?g/kg) was administered intravenously, and then the subjects were randomly assigned to one of three groups. Group I (n=20) received a remifentanil 1 ?g/kg as loading and bolus dose and infusion of 0.01 ?g/kg/min; Group II (n=20) received a remifentanil 0.5 ?g/kg as loading and bolus dose and infusion of 0.05 ?g/kg/min; Group III (n=20) received a remifentanil 0.1 ?g/kg as loading and bolus dose and infusion of 0.1 ?g/kg/min. Two minutes after applying loading dose with PCA, ESWL procedure was started. Hemodynamic and respiratory data, adverse effects such as nausea, vomiting, dizziness, level of pain and sedation were recorded. The end of ESWL procedure, consumption of remifentanil was recorded. After satisfactions of patients were registered, the patients fully recovered discharged from hospital. In Group I and Group II, level of pain was significantly lower than Group III (p<0.05). In Group I, frequency of respiratory and hemodynamic depression was higher than other group. However, In Group III, incidences of nausea, vomiting and dizziness were higher than other group. Satisfactions of patients were statistically highest in Group II. Moreover, consumption of remifentanil was lowest in Group II. No difference was among three group in discharge time from hospital. We concluded that for monitored anaesthesia care during ESWL, remifentanil at loading and bolus dose of 0.5 ?g/kg and infusion rate of 0.05 ?g/kg/min provided effective analgesia and had low incidence of adverse effects in patients had been received droperidol.
