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Öğe Anaesthetic management of an extremely obese woman undergoing open gastric bypass(Lippincott Williams & Wilkins, 2006) Akbay, Buket Kocaman; Hayıt, Feray; Pehlivan, Mevlüt; Ağartan, CananObesity poses significant anaesthetic and surgical challenges [1–4]. Overweight is defined as a body mass intraoperative management and postoperative anaesthetic care require an understanding of the pathophysiological and pharmacological dynamics of extreme obesity.Öğe Efficacy of topical levobupivacaine in control of postoperative pain after septoplasty(Bmc, 2010) Yılmaz, Süleyman; Akbay, Buket Kocaman; Yıldızbaş, Şahnur; Güçlü, Ender; Yaman, Hüseyin; Sezen, Gülbin YalçınObjective: To search the efficacy of using Merocele (Medtronic, Minneapolis, MN) soaked with 5 mL of levobupivacaine hydrocloride as a nasal pack in control of postoperative pain after septoplasty. Design: The study was designed as a prospective, double-blind, randomized, controlled study. Forty-one patients who underwent septoplasty operation were included in the analysis. Setting: A tertiary referral hospital in Turkey. Material and Methods: Forty-one patients undergoing septoplasty were divided into two groups. At the end of the operation, Merocele packs were placed inside the nasal cavity. In the levobupivacaine group, each Merocele pack was soaked with 5 mL of levobupivacaine hydrochloride (25 mg/10 mL), and in the control group, Merocele packs were soaked with 5 mL of saline. Main Outcome Measures: Postoperative pain levels were recorded using a visual analogue scale (VAS score, 0-100) at 30 minutes and 1, 2, 8, 12, and 24 hours. Results: We did not find any significant difference between groups regarding age, gender, American Society of Anesthesiologists status, and body mass index. Postoperative VAS values at 30 minutes and 1, 2, 8, and 12 hours were significantly lower in the levobupivacaine group compared with the control group (p < .05). The need for supplemental analgesia was significantly lower in the levobupivacaine group compared with the control group (p < .01) Conclusion: Postoperative pain after septoplasty owing to nasal packing is an important problem, and using levobupivacaine-soaked Merocele as a nasal pack after septoplasty is an effective method for the control of this pain. It is a very easy, effective, and quick method and it improves patient comfort after septoplasty.Öğe Emergency thoracic epidural anesthesia wıth ropivacaine for a cachectic geriatric patient with ileus(2006) Akbay, Buket Kocaman; Hayıt, Feray; Özaydın, İsmet; Zengin, Ahmet; Demiraran, YavuzObjective: Operations associated with increased risk of perioperative mortality and morbidity lead to consider regional anesthesia techniques for elderly patients. Epidural analgesia is used widely combined with general anesthesia. In this case, it is discussed whether solely thoracic epidural technique with ropivacaine provide appropriate anesthesia or not in emergency situations for elderly patients. Case Report: A 73-year-old cachectic male diagnosed with ileus was scheduled for an emergency laparotomy. He had congestive heart failure with hypertension, tachycardia and tachypnea with jugular venous distension. Thoracic epidural anesthesia were performed with ropivacaine 75 mg. Total colectomy and ileorectal anastomosis were performed. The patient discharged uneventful postoperatively. Conclusion: Epidural anesthesia with ropivacaine was provided fast and effective anesthesia without sedation in the elderly patient with ileus. This technique should be used safely especially with it's advantages for cardiovascular and pulmonary compromised elderly patients.Öğe Use of the bispectral index to predict a positive awareness reaction to laryngeal mask airway-fastrach insertion and intubation(Wiley, 2007) Akbay, Buket Kocaman; Demiraran, Yavuz; Sezen, Gülbin Yalçın; Akçalı, Gülgün; Somunkıran, AslıAim: To determine whether the bispectral index (BIS) can be monitored to predict and indicate an awareness reaction to laryngeal mask airway-Fastrach (LMA-Fastrach) insertion and intubation at BIS values between 40 and 60. Methods: Fifty-one American Society of Anesthesiologists' (ASA) class I or II status patients aged over 20 years were included in this study. Midazolam 0.1 mg/kg was given for pre-medication, 30 min before induction. For induction, a 0.1-mu g/kg bolus injection of remifentanil was followed by infusion, and propofol was administered until the eyelash reflex disappeared; the infusion rate was adjusted to maintain BIS values between 40 and 60. Loss of the eyelash reflex, loss of response to verbal commands, yawning and total propofol consumption were recorded. Patients were tested for awareness twice at 1-min intervals using the isolated forearm technique. The test was considered to be positive if the patient squeezed a hand when asked; after muscle relaxation, the patient was intubated and the test was repeated. In the recovery room and ward, patients were asked whether they could recall this event. Results: Seven patients tested positive: two following LMA-Fastrach insertion and the remaining five following intubation. None of the patients had recall. Conclusion: Awareness during anaesthesia may occur at BIS levels that indicate adequate anaesthesia, but this is not associated with recall of the events later.
