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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 Comparison of general and spinal anaesthesia in pregnant women with pregnancy induced hypertension(1999) Turhanoglu S.; Tok D.; Ozyilmaz M.A.; Bayhan N.; Olmez G.; Kaya S.; Yayla M.The technique of anaesthesia may become important when caeseraen section will be necessary instead of vaginal delivery in pregnant women with pregnancy induced hypertension. In our study, we compared general versus spinal anaesthesia in hypertensive pregnant women who had the same clinical conditions. Sixty pregnant women had taken to the study and allocated randomly into two groups. In the first group (n=30) general anaesthesia, and in second group (n=30) spinal anaesthesia were administered to the patients. Heart rate (HR), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) in the periods of pre, per (1., 3., 5. minutes and every 5 minute for thirty minutes) and postoperative (1., 30. and 60. minutes), APGAR scores at 1. and 5. minutes, uterine incision-cordon clamping time (Ui-Cc) and the time of first analgesic requirement in the postoperative period were recorded. The values of HR, SAP and DAP were significantly lower in the group of spinal anaesthesia (p<0.05). APGAR scores at the first minute were found significantly better in the group of spinal anaesthesia than the group of general anaesthesia (p<0.05). The times of first analgesic requirements were significantly shorter in the group of general anaesthesia (p<0.05). We concluded that spinal anaesthesia may be performed in preeclamptic women undergoing caeserean section with safe if the anaesthesiologist takes the necessary measures.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 ELF electromagnetic field and strontium ranilate influences on the trace element content of rat teeth(2009) Kaya S.; Akdag M.Z.; Yavuz I.; Celik M.S.; Adiguzel Ö.; Tumen E.C.; Kaya F.A.Exposure to Extremely Low Frequency (ELF) Electromagnetic Field (EMF) emanating from the generation, distribution and utilization of electricity. The major debate in recent years has focused on the possibility that exposure to EMF may result some health consequences such as differentiation on bone constitute. In this study, the effect of ELF-EMFs and strontium ranelate on teeth constitute amount of mineral were investigated in rats. Seventy-five four month old adult female Sprague-Dawley rats were randomly divided into 5 different groups (n = 15). After all applications, some mineral levels such as: Ca, Mg and Zn in rat teeths were determined with Atomic Absorbtion Spectrophotometry (AAS) and the phosphorus content of teeth was determined by Ultraviolet Spectrophotometer (UVS). It was determined that the levels of Ca and P were not statistically different in comparison to Cg-Cnt and between groups (p>0.05). However, it was observed that the levels of Zn significantly alterations between some groups (p<0.05). The levels of Mg in ELF-EMF+OVX, ELF-EMF and OVX groups decreased significantly in comparison to Cg-Cnt group (p<0.05). As a resulf it can be suggested that mineral amount of rat teeth can change after ovariectomy and ELF-EMF exposure, also strontium ranelate treatments can't increase mineral amount of teeth. © Medwell Journals, 2009.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 Fatal interstitial pneumonia as an adverse reaction in patient with rheumatoid arthritis: A case report(2008) Kaya S.; Turhanoğlu S.; Turhanoğlu A.D.Acute interstitial pneumonia developed three weeks after the administration of leflunomide(LEF) in a 53-year-old woman with rheumatoid arthritis. She developed nausea and diarrhea as well as dyspnea before coming to the hospital and LEF treatment was stopped. She suddenly experienced severe dyspnea and her chest x-ray showed reticular shadows in her lower lung fields which had not been detected before. Partial oxygen pressure of her arterial blood fell all of a sudden, which necessitated an emergency admission to the intensive care unit. After endotracheal intubation, mechanical ventilation support was started due to acute respiratory failure. The patient died of respiratory failure 7 days after the onset of acute interstitial pneumonia.Öğe An interdisciplinary approach in a patient with amelogenesis imperfecta: A clinical report and literatüre review(2012) Ulku S.Z.B.; Callea M.; Yavuz I.; Clarich G.; Kaya F.A.; Maglione M.; Kaya S.This clinical report describes an interdisciplinary approach for the coordinated treatment of a 20-year-old woman patient diagnosed with amelogenesis imperfecta. The treatment objective was to restore masticatory function, to reduce dental sensitivity and improve the facial esthetics. A multidisciplinary team approach treatment is recommended, including periodontology, orthodontics, endodontics, and prosthodontics. Prosthodontic treatment included composite laminate veneers and metal-ceramic fixed partial dentures. After treatment the patient was regularly recalled during the 25-months postoperative period. Radiographic and clinical examinations at recall revealed no evidence of complications associated with the restored teeth or their supporting structures.Öğe Our applications of percutaneous vertebroplasty in vertebra plana type compression fractures associated with osteoporosis(2011) Karaman H.; Öztürkmen Akay H.; Aslanhan Taze H.A.; Kaya S.; Ölmez Kavak G.; Balkan B.The indication area of percutaneous vertebroplasty, which was first applied successfully for the management of aggressive vertebral hemangioma in 1987 in France, has grown in the years. One of these indications is osteoporotic vertebral compression fractures. Osteoporosis, common amongst elderly patients causes significant compression fractures. Most of the fractures that do not cause pressure on the spinal canal are successfully treated with percutaneous vertebroplasty. However most authors, claiming that in cases of severe vertebral compression fracture (vertebra plana) associated with osteoporosis, cement leakage developing due to technical difficulties may cause dangerous complications such as emboli, death and disability, asserted that the application of percutaneous vertebroplasty is contraindicated. This study, presenting successful ercutaneous vertebroplasty in two patients with the vertebra plana type compression fracture associated with osteoporosis, underlines that as long as it is performed meticulously, the complication risk in percutaneous vertebroplasty is very low.Öğe The prevelance and etiology of dental trauma among 5-72 months preschool children in South-Eastern Anatolia, Turkey(2009) Tumen E.C.; Adiguzel O.; Kaya S.; Uysal E.; Yavuz I.; Atakul F.The main objective of this study was to assess the epidemiology of traumatic dental injuries to the primary teeth in children from 5 to 72 months, all atendees in 11 public nursery schools in South-Eastern Anatolia, Turkey. A total of 657 children (346 boys and 311 girls) of both sexes participated in the study. Traumatic dental injuries were classified according to the modified classification proposed by Ellis. An interview was carried out by two trained and calibrated examiners, and clinical oral examinations included distribution of dental injuries by age and sex, etiology of dental trauma, prevelance of affected teeth and type of damage. All results were analyzed using the Statistical Package for Social Sciences (SPSS) software, version 15.0. The prevalence of traumatic dental injuries was 5.02%. There was greater involvement of boys (78.8%), of children aged 37-48 months (63.63%) and of the maxillary central incisors (92.68%). Falls were more often the etiology for dental injuries (66.7%). Most children with a traumatic dental injuries experienced traumatic injuries to one tooth (3.81%), while 1.21% had two traumatized teeth and 94.9% had no traumatic dental injuries. The most common crown fracture was in enamel only (65.9%), followed by discoloration teeth (14.6%). The prevalence of dental injuries in Turkish preschool children was very low. The present study findings emphasize the importance of encouraging parents to visit the dentist with their child at an early stage. Moreover, traumatic dental injury is widespread in the population; it has both physical and psychological effects, it is treatable; and, most importantly, it is preventable.Öğe The protective effect of dexmedetomidine on bupivacaineinduced sciatic nerve inflammation is mediated by mast cells(2013) Tüfek A.; Kaya S.; Tokgöz O.; Firat U.; Evliyaoğlu O.; Çelik F.; Karaman H.Purpose: This study was designed to assess the correlation between the neuroprotective effect of dexmedetomidine and oxidative stress, neural inflammation and mast cell stability in rats with bupivacaine-induced sciatic nerve toxicity. Methods: Forty adult Wistar Albino rats, eight rats per group, were used. Saline (0.3 ml of 0.9%), dexmedetomidine (20 ?g/kg), 0.5% bupivacaine or 0.5% bupivacaine+dexmedetomidine (20 ?g/kg) was injected into the sciatic nerve. A control group of rats received no injection. Fourteen days after injection, the sciatic nerves were harvested and total oxidant status, total anti-oxidant status, paraoxonase-1, galectin-3 and matrix metalloproteinase 2 and 9 levels were measured in the sciatic nerves. In addition, the presence and status of inflammation, edema, and mast cells were evaluated histopathologically. Results: The combination of dexmedetomidine and bupivacaine alleviated oxidative stress. In addition, it decreased matrix metalloproteinase 9 and galectin-3 levels and increased matrix metalloproteinase 2 levels. Moreover, it stabilized recruited mast cells at the injury site; however, it did not significantly decrease inflammation or edema. Conclusion: Dexmedetomidine may ameliorate bupivacaine-induced neurotoxicity by modulating mast cell degranulation. The neuroprotective effect of dexmedetomidine may make it a suitable adjuvant agent to local anesthetics in peripheral nerve blocks.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.Öğe The role of L-Arginine, a nitric oxide precursor, on deteriorating cardio-respiratory effects in experimentally produced traumatic diaphragmatic injury(2002) Öztürk H.; Gezici A.; Otçu S.; Dokucu A.I.; Kaya S.; Kirbaş G.; Yücesan S.Aim: In this study we aimed to in vestigate the protective effects of L-Arginine on cardio-respiratory complications in a diaphragmatig rupture model. Method: 40 Sprague-Dawley rats were used in this study. In Group I, only thoracotomy was performed. In Group II, III and IV, following left thoracotomy, the stomach was pulled into thorax and the intraabdominal pressure was increased by an insufflator. L-Arginine (L-Arg) was given in GIII and L-NAME was given in GIV at the 45th minute of the study, The parameters such as arterial blood pressure (BP), heart rate (HR), arterial blood gases analysis (pO2, pCO2, pH) and pulmonary scintigraphy were measured at the baseline, 30th, 45th and 60th minutes of the study. The left lungs were extracted for histopathological examination. Results: In the values of blood gases analysis following the performing herniation model the pO2 and pH values decreased and pCO2 values increased in GII in comparison with GI. The mean values of blood gases analysis in GIII following L-Arg infusion at the 60th minute of the study were found to be increased for pO2 and pH values and to be decreased for pCO2 values in comparison with the values of GII. Following L-NAME administration to the GIV, there was no difference found between GII and GIV. Pulmonary uptake decreased in GII, GIII and GIV when compared with GI, whereas pulmonary uptake in GIII was significantly increased in comparison with GII and GIV. Conclusion: The use of the precursor of nitric oxide, L-Arginine, may provide protective effects on cardio-respiratory complications related to organ herniation in the acute period of traumatic diaphragmatic rupture.
