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Öğe Accidental epidural injection of ephedrine(Churchill Livingstone, 2004) Olmez, G; Yalinkaya, A[Abstract Not Available]Öğe Clinical investigation: Thyroid function test abnormalities in cardiac arrest associated with acute coronary syndrome(Bmc, 2005) Iltumur, K; Olmez, G; Ariturk, Z; Taskesen, T; Toprak, NIntroduction It is known that thyroid homeostasis is altered during the acute phase of cardiac arrest. However, it is not clear under what conditions, how and for how long these alterations occur. In the present study we examined thyroid function tests (TFTs) in the acute phase of cardiac arrest caused by acute coronary syndrome (ACS) and at the end of the first 2 months after the event. Method Fifty patients with cardiac arrest induced by ACS and 31 patients with acute myocardial infarction ( AMI) who did not require cardioversion or cardiopulmonary resuscitation were enrolled in the study, as were 40 healthy volunteers. The patients were divided into three groups based on duration of cardiac arrest (< 5 min, 5 - 10 min and > 10 min). Blood samples were collected for thyroid-stimulating hormone (TSH), triiodothyronine (T-3), free T-3, thyroxine (T-4), free T-4, troponin-I and creatine kinase-MB measurements. The blood samples for TFTs were taken at 72 hours and at 2 months after the acute event in the cardiac arrest and AMI groups, but only once in the control group. Results The T-3 and free T-3 levels at 72 hours in the cardiac arrest group were significantly lower than in both the AMI and control groups ( P < 0.0001). On the other hand, there were no significant differences between T-4, free T-4 and TSH levels between the three groups ( P > 0.05). At the 2-month evaluation, a dramatic improvement was observed in T-3 and free T-3 levels in the cardiac arrest group ( P < 0.0001). In those patients whose cardiac arrest duration was in excess of 10 min, levels of T-3, free T-3, T-4 and TSH were significantly lower than those in patients whose cardiac arrest duration was under 5 min ( P << 0.001, P < 0.001, P < 0.005 and P < 0.05, respectively). Conclusion TFTs are significantly altered in cardiac arrest induced by ACS. Changes in TFTs are even more pronounced in patients with longer periods of resuscitation. The changes in the surviving patients were characterized by euthyroid sick syndrome, and this improved by 2 months in those patients who did not progress into a vegetative state.Öğe Comparison of the effects of remifentanil and alfentanil on cardiovascular response to nasotracheal intubation: A prospective, randomized, double-blind study(Excerpta Medica Inc, 2005) Olmez, G; Ozyilmaz, MA; Menekse, ABackground: Nasotracheal intubation is often necessary in patients undergoing elective or emergency maxillofacial surgery. Previous studies have suggested that the increase in blood pressure after nasotracheai intubation is significantly greater than the increase after orotracheal intubation. Many drugs, including narcotic analgesics, are effective in modifying cardiovascular responses to orotracheal intubation. Objective: The effects of remifentanil and alfentanil on the cardiovascular responses to nasotracheal intubation were compared in healthy patients scheduled to undergo surgery. Methods: This prospective, randomized, double-blind study was conducted at the Department of Anesthesiology and Reanimation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. Patients aged 16 to 65 years scheduled to undergo elective maxillofacial surgery and who were American Society of Anesthesiologists status I or II were randomly assigned to receive remifentanil 1 mu g/kg in 10 mL, saline over 30 seconds followed by an infusion of 0.5 mu g/kg center dot min, or alfentanil 10 mu g/kg in 10 ml, saline over 30 seconds followed by an infusion of saline. Anesthesia was then induced with propofol, cisatracurium, and 1% isoflurane with 66% nitrous oxide in oxygen. Heart rate (HR) and systolic and diastolic arterial pressures (SAP and DAP, respectively) were measured noninvasively at 2 minutes before general anesthesia induction (baseline); 2 minutes after induction; and 1, 3, and 5 minutes after nasotracheal intubation. Patients were monitored for cardiac changes using electrocardiography. Results: Forty consecutive patients were enrolled in the study. Twenty patients (11 males, 9 females; mean [SD] age, 27.7 [12.6] years) received remifentanil, and 20 patients (12 males, 8 females; mean [SD] age, 31.5 [17.2] years) received alfentanil. Two minutes after anesthesia induction, mean (SD) arterial pressures decreased significantly from baseline in the remifentanil group (changes, 22 [8]/11 [6] mm Hg) and the alfentanil group (changes, 10 [9]/12 [8] mm Hg) (both, P < 0.05). Changes in SAP and DAP followed a similar pattern in both groups, but SAP was significantly lower in the remifentanil group compared with that in the alfentanil group throughout the study period (all, P < 0.05). After 1 minute of intubation, DAP was significantly lower in the remifentanil group compared with that in the alfentanil group (66 [9] mm Hg vs 73 [20] mm Hg; P < 0.05). Compared with baseline, HR was decreased significantly in both groups throughout the study (all, P < 0.05). Except SAP in the alfentanil group, SAP, DAP, and HR were increased I minute after intubation compared with preintubation values. However, SAP, DAP, and HR remained significantly lower compared with baseline values throughout the study period in both groups (all, P < 0.05) except DAP at I minute after intubation in the alfentanil group. Five patients in the remifentanil group and 2 patients in the alfentanil group required treatment of hypotension. None of the patients in either group required treatment of bradycardia. Conclusions: In this study in healthy surgical patients aged 16 to 65 years, remifentanil 1 mu g/kg given over 30 seconds, followed by a remifentanil infusion of 0.5 mu g/kg center dot min, was similarly effective compared with alfentanil 10 mu g/kg in attenuating the pressor response to nasotracheal intubation, but the incidence of hypotension in patients administered remifentanil was high.Öğe The effects of intracameral ropivacaine on the corneal endothelium(Springer Japan Kk, 2005) Cakmak, SS; Olmez, G; Nergiz, Y; Unlu, K; Soker, S[Abstract Not Available]Öğe Effects of intravitreal ropivacaine on retinal thickness and integrity in the guinea pig(Excerpta Medica Inc, 2005) Olmez, G; Cakmak, SS; Soker, SI; Nergiz, Y; Yildiz, FBackground: Retrobulbar anesthesia is widely used for ocular surgery. Ocular complications are possible when retrobulbar anesthesia is accidentally injected intravitreally. Objective: The aim of this study was to determine the relative retinal toxicities of ropivacaine hydrochloride, a local anesthetic, using various concentrations in guinea pigs. Methods: This randomized, investigator-masked, experimental study was conducted at the Department of Anesthesiology, Dicle University, Diyarbakir, Turkey. The right eyes of 18 guinea pigs were assigned to I of 3 treatment groups: 1%, 0.75%, or 0.5% ropivacaine. The right eye of each animal was injected intravitreally with 0.1 mL of 1%, 0.75%, or 0.5% ropivacaine. The left eye of each animal was injected with a balanced saline solution (control). The guinea pigs were euthanized 7 days after injection, and the retinal structures were examined using light microscopy. The total thickness of each retina was measured using an ocular micrometer. Results: No histologic abnormalities were observed in the control eyes. Retinal damage of most of the retinal section was seen in the eyes receiving study drug. The eyes injected with 0.5% ropivacaine had a generally intact appearance, with the exception of some atrophy and disorganization. Overall, the eyes injected with 1% ropivacaine had significantly more extensive retinal thinning compared with the eyes injected with 0.75% or 0.5% ropivacaine (both, P < 0.01). In the eyes injected with 0.75% or 1% ropivacaine, disorganization of the structure of the retinal layers and atrophy were noted on histopathology. The mean total thicknesses of the retina were significantly less in all ropivacaine-treated eyes compared with that in the controls (P < 0.001). Conclusions: In this small experimental study, ropivacaine had concentration dependent toxic effects on guinea pig retinas.Öğe Intraocular pressure and quality of blockade in peribulbar Anesthesia using ropivacaine or lidocaine with adrenaline: A double-blind randomized study(Tohoku Univ Medical Press, 2004) Olmez, G; Cakmak, SS; Caca, I; Unlu, MKThe aim of this study was to compare the effects of ropivacaine with those of lidocaine on the intraocular pressure (IOP) and the quality of the blockade in peribulbar anesthesia for cataract surgery. Fifty patients were allocated randomly into two groups and received 7-10 ml of 0.75% ropivacaine or 2% lidocaine with adrenaline, though the peribulbar two-point injection. The quality of the blockade was assessed by ocular and eyelid akinesia, pain during the peribulbar injection, and surgical satisfaction. The duration of the motor block was also evaluated after surgery. The IOP was measured using a Tonopen before the blockade (control) and at 1, 5, and 10 min after injection of the anesthetic. Lidocaine induced significantly lower akinesia scores at 6, 8, and 10 min post-injection than did ropivacaine. The mean IOP (mmHg) was significantly lower with respect to the baseline level at 10 min after blockade in the ropivacaine group compared with the lidocaine group. Ropivacaine also caused less pain on injection. There was no difference in surgical satisfaction between the groups. The duration of the motor block obtained with ropivacaine was longer than that obtained with lidocaine. Our data indicate that ropivacaine has efficacy similar to lidocaine, with slightly longer onset and duration of the motor blockade. In addition, ropivacaine (0.75%) induces lower IOP and less pain on injection than does lidocaine (2%) when used in peribulbar anesthesia for cataract surgery. (C) 2004 Tohoku University Medical Press.Öğe Penetrating eye injuries from southeastern Anatolia region of Turkey(W B Saunders Co Ltd, 2004) Cakmak, SS; Unlu, MK; Olmez, G; Caca, I; Sakalar, YB; Acemoglu, HObjectives. This study analysed 420 patients with penetrating eye injuries who presented for treatment at the Eye Clinic of Dicle University Hospital in Turkey. The aim of the study was to identify preventable risk factors. Methods. A retrospective evaluation of patients who presented between January 1995 and December 2000 was undertaken. Cases were examined with regard to age, sex, profession, which eye was traumatized, reason for the trauma, nature of the trauma, time between injury and operation, and accompanying pathologies. Results. This study found that most penetrating eye injuries occurred in children aged 0-15 years, and these were mainly caused by accidents during play. For patients aged 16-60 years, penetrating eye injuries were mainly caused by work-related accidents. Conclusion. Most penetrating eye injuries were caused by preventable accidents. Many accidents and their resulting injuries could have been prevented by education, greater intensive care and workplace safety. (C) 2004 The Royal Institute of Public Health. Published by Elsevier Ltd. All. rights reserved.Öğe Surgical technique and postoperative complications in congenital cataract surgery(Int Scientific Information, Inc, 2006) Cakmak, SS; Caca, I; Unlu, MK; Cakmak, A; Olmez, G; Sakalar, YBBackground: We evaluated cases that under-went congenital cataract surgery in terms of the surgical technique post-operative complications, and visual prognosis. Material/Methods: We retrospectively evaluated 132 eyes in 76 patients with congenital cataracts who underwent cataract surgery between January 1995 and December 2000. The patient age at surgery, surgical technique, post-operative complications, and final visual prognosis were evaluated. Results: Thirty eyes underwent aspiration, posterior capsulotomy, and intraocular lens (IOL) implantation; 22 eyes underwent aspiration and posterior capsulotomy; 39 eyes underwent aspiration, posterior capsulotomy, and anterior vitrectomy; and 41 eyes underwent aspiration, posterior capsulotomy, anterior vitrectomy, and IOL implantation. The most frequent complications were secondary cataract (24.2%), posterior synechiae (9.1%), and glaucoma (3%). Groups were compared according to surgical technique and incidence of complications. Complications occurred most frequently with aspiration and posterior capsulotomy and occurred less frequently with aspiration, posterior capsulotomy, and anterior vitrectomy; these differences were statistically significant (p < 0.05). The difference in the final visual prognosis was statistically significant in the aspiration, posterior capsulotomy, anterior vitrectomy, and IOL implantation groups as compared with the other groups (p < 0.05). The mean follow up times was 15.5 +/- 1.78 months. Conclusions: The most frequent complication of congenital cataract surgery is secondary cataract formation. Today, posterior capsulotomy with anterior vitrectomy is the preferred method for decreasing the incidence of this complication.
