Yazar "Kararmaz A." seçeneğine göre listele
Listeleniyor 1 - 7 / 7
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe Beneficial effects of single dose multimodal epidural analgesia on relief of postoperative microdiscectomy pain(2004) Kararmaz A.; Kaya S.; Karaman H.; Turhano?lu S.; Özyilmaz A.We aimed to assess the efficacy of multimodal epidural analgesia in decreasing postoperative pain after microdiscectomy. Fourty patients, ASA physical status I or II, undergoing microsurgical lumbar discectomy were enrolled in this prospective, randomised, controlled, double-blinded study. 10 ml study solution consisting of 2 mg of morphine, 15 mg of bupivacaine, 80 mg of methylprednisolone, and 0.05 mg of adrenaline was prepared for epidural administration. At the end of the procedure but prior to wound closure, the surgeon inserted an 18-gauge epidural catheter into the epidural space. After closure of incision, patients were assigned to receive either study solution (Group E) or saline (Group C). The epidural catheter was then removed. Patient controlled analgesia with morphine was used for postoperative analgesia. Visual Anologue Scale (VAS) pain scores and morphine consumptions were lower in Group E. Time to first ambulation was shorter in Group E. Patients in Group E were more satisfied with their analgesic regimen. Single dose multimodal epidural analgesia administered after wound closure provided better postoperative analgesia after lumbar microdiscectomy.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 The effect of lidocain infiltration applied pre or postoperatively on postoperative pain after inguinal hernia repair(2003) Önen A.; Kararmaz A.; Tosyali A.N.; Otiçu S.; Öztürk H.; Dokucu A.I.; Kaya M.Aim: To compare the effect of lidocain infiltration applied pre or postoperatively on postoperative pain after inguinal hernia repair. Method: Eighty-one children between 2 to 9 years of age who underwent inguinal hernia repair were reviewed prospectively. The patients were divided into three groups. Control group patients (n=20) underwent herniectomy alone. Five mg/kg lidocain 1% was infiltrated into the incision area 5 minutes before incision in preincisional group (n=35) and at the end of operation in postincisional (n=26) group. The severity of postoperative pain was evaluated by 4 staged pain scale. Results: Sixty-nine were boys and 12 were girls. Thirty-six had right-sided, 31 had left-sided, and 14 had bilateral inguinal hernia. The mean age was 3.6±1.9 years in control, 4.3±2.01 years in preincisional, and 3.3±1.6 years in postincisional group. The mean postoperative pain score was 0.65±0.75 in pre-incisional group, 0.80±0.87 in post-incisional group, and 1.7±0.78 in control group. While there was no significant difference between study groups, the postoperative pain score was significantly higher in control group compared to lidocain groups (p<0.001). The first analgesic demand time was 128.4±46.08 minutes in pre-incisional, 83.6±29.88 in post-incisional, and 27.2±14.9 in control group. The first analgesic demand time was significantly higher in pre-incisional group compared to others (p<0.001). Conclusion: Perioperative local infiltration of lidocain, which does not need additional equipment and experience, seems to be easy to perform, safe, and effective in decreasing postoperative pain after hernioplosty. In addition, the pre-incisional infiltration of lidocain allows more long postoperative painless period.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 Factors associated with postoperative morbidity in patients underwend hip replacement surgery(2004) Kararmaz A.; Menekşe A.; Yüksel Ş.; Kaya S.; Turhano?lu S.We aimed to evaluate whether preoperative health conditions, the anesthetic technique and intraoperative events such as hypotension, blood replacement were associated with postoperative morbidity in patients undergoing hip replacement surgery. Preoperative risk factors were recorded before the surgery. Ninety patients undergoing hip arthroplasty were randomized to receive either epidural or general anesthesia. Intraoperative events such as bradycardia, hypotension, tachycardia and hypoxia were recorded. During postoperative period, major complications and postoperative mortality were also recorded. The effects of risk factors and anesthesia techniques on postoperative morbidity were investigated by logistic regression analysis. Age (p=0.003), ASA (p=0.015), diabetes mellitus (p=0.045), congestive heart failure (p=0.024) and Goldman risk index (p=0.014) were found to be associated with postoperative morbidity. Ambulation time was significantly lower in the epidural anesthesia group (p<0.05). Mortality rate in the general anesthesia group was 9%, compared with 7% in the epidural anesthesia group (p=0.666) We concluded that the anesthesia technique is not related to postoperative morbidity. Our findings suggest that the incidence of postoperative morbidity increases in patients with diabetes mellitus, congestive heart failure and advanced age. ASA and Goldman cardiac risk indexes are useful to predict postoperative morbidity. We believe that during decision of anesthesia technique, it would be more suitable to determine factors other than factors influencing postoperative mortality or morbidity.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.
