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Öğe Comparison of costs and efficacy of intravenous and orally disintegrating ondansetron tablet as a prophylactic antiemetic therapy in major gynecologic operations(2005) Demiraran, Yavuz; Özdemir, Ismail; Kocaman, Buket; Hayit, Feray; Demirci, FuatObjective: The aim of the study is to compare the antiemetic efficacy and costs of oral rapid disintegrating ondansetron tablets and intravenously administered ondansetron in patients undergoing major gynecologic surgery. Materials and Methods: Anesthesia was induced with thiopenthone, vecuronium and fentanyl. Nitrous oxide and sevoflurane were used to maintain anesthesia. Patients were prospectively randomized into three groups of 30 patients each, receiving either ondansetron 8 mg intravenously or saline infusion only or oral rapid disintegrating tablets of 8 mg ondansetron. The patients were evaluated for nausea and vomiting at 1st, 5th, 10th, 20th, 30th, 60th, and 120th minutes and 6th hours postoperatively. Results: There were no significant differences in adverse effects between placebo group, intravenous ondansetron group and oral ondansetron group (P>0.05). The incidence rates of nausea, vomiting and the need of metoclopropamide were higher in placebo group than intravenous and oral ondansetron groups (P<0.05). Conclusion: Postoperative nausea and vomiting are common during recovery from general anesthesia. Both oral and intravenous forms of ondansetron are efficacious in the prevention of this postoperative nausea and vomiting. Orally disintegrating tablets are inexpensive and may be administered more easily than the intravenous form of ondansetron. Therefore, oral ondansetron tablet may be an alternative to intravenous ondansetron infusion for postoperative nausea and vomiting after major gynecologic operations.Öğe Comparison of Costs and Efficacy of Intravenous and Orally Disintegrating Ondansetron Tablet as a Prophylactic Antiemetic Therapy in Major Gynecologic Operations(Galenos Yayincilik, 2005) Demiraran, Yavuz; Ozdemir, Ismail; Kocaman, Buket; Hayit, Feray; Demirci, FuatObjective: The aim of the study is to compare the antiemetic efficacy and costs of oral rapid disintegrating ondansetron tablets and intravenously administered ondansetron in patients undergoing major gynecologic surgery. Materials and Methods: Anesthesia was induced with thiopenthone, vecuronium and fentanyl. Nitrous oxide and sevoflurane were used to maintain anesthesia. Patients were prospectively randomized into three groups of 30 patients each, receiving either ondansetron 8 mg intravenously or saline infusion only or oral rapid disintegrating tablets of 8 mg ondansetron. The patients were evaluated for nausea and vomiting at 1st, 5th, 10th, 20th, 30th, 60th, and 120th minutes and 6th hours postoperatively. Results: There were no significant differences in adverse effects between placebo group, intravenous ondansetron group and oral ondansetron group (P>0.05). The incidence rates of nausea, vomiting and the need of metoclopropamide were higher in placebo group than intravenous and oral ondansetron groups (P<0.05). Conclusion: Postoperative nausea and vomiting are common during recovery from general anesthesia. Both oral and intravenous forms of ondansetron are efficacious in the prevention of this postoperative nausea and vomiting. Orally disintegrating tablets are inexpensive and may be administered more easily than the intravenous form of ondansetron. Therefore, oral ondansetron tablet may be an alternative to intravenous ondansetron infusion for postoperative nausea and vomiting after major gynecologic operations.Öğe The comparison of dexmedetomidine and midazolam used for sedation of patients during upper endoscopy: A prospective, randomized study(Hindawi Ltd, 2007) Demiraran, Yavuz; Korkut, Esin; Tamer, Ali; Yorulmaz, İlknur; Kocaman, Buket; Sezen, Gülbin; Akcan, YusufThe aim of the present prospective, randomized study was to investigate and compare the safety and efficacy of dexmedetomidine versus midazolam in providing sedation for gastroscopy. A total of 50 adult patients (25 patients receiving dexmedetomidine and 25 patients receiving midazolam), 18 to 60 years of age, and rated I and II on the American Society of Anesthesiologists physical status classification system were included. A brief questionnaire was used to collect demographic data; patients were asked to rate anxiety, satisfaction wit care to data and expected discomfort on a visual analogue scale. The following parameters were measured continuously and recorded every minute; heart rate, mean arterial pressure, hemoglobin oxygen saturation and respiratory rate. The two groups were similar with regard to age, body mass index, sex, education, duration of endoscopy, and ethanol or tobacco use. After the procedure, full recovery time, mean arterial pressure, heart rate, respiratory rate and hemoglobin oxygen saturation levels were similar in both groups. Both groups also had low levels of perceived procedural gagging, discomfort and anxiety scores (P > 0.05), and high satisfaction levels (90.1+/-3.0 for dexmedetomidine versus 84.9+/-4.5 for midazolam; P>0.05). Retching and endoscopist satisfaction were significantly different in patient receiving dexmedetomidine versus those receiving midazolam (88.8+/-6.5 versus 73.5+/-16.4, P<0.05; and 20.6+/-4.4 versus 45.2+/-6.0; P<0.001). In the midazolam group, the number of patients who had adverse effects was higher than the dexmedetomidine group (P<0.05). As a result, dexmedetomidine performed as effectively and safely as midazolam when used as a sedative in upper gastroscopy; it was superior to midazolam with regard to retching, rate of side effects and endoscopist satisfaction. It was concluded that dexmedetomidine may be a good alternative to midazolam to sedate patients for upper endoscopy.Öğe Comparison of high-dose extracorporeal shockwave therapy and intralesional corticosteroid injection in the treatment of plantar fasciitis(Amer Podiatric Med Assoc, 2010) Yücel, İstemi; Özturan, Kutay Engin; Demiraran, Yavuz; Değirmenci, Erdem; Kaynak, GürselBackground: The aim of this study was to evaluate the results of high-dose extracorporeal shockwave therapy applied with an ankle block and corticosteroid injection in patients with plantar fasciitis whose symptoms persisted for more than 6 months. Methods: Sixty patients were assessed clinically at presentation and at 3-month follow-up with a patient-assessed 100-mm visual analog scale of pain and a physician-assessed heel tenderness index. A therapeutic response rate was evaluated. A decrease of at least 50% from baseline to 3 months in visual analog scale or heel tenderness index scores was accepted as a successful result. Results: Extracorporeal shockwave therapy and corticosteroid injection provided significant improvements in visual analog scale and heel tenderness index scores, but between the two groups there was no significant difference in the visual analog scale score change 3 months after treatment (P > .05). Twenty-seven of 33 patients (82%) in the extracorporeal shockwave therapy group and 23 of 27 (85%) in the corticosteroid injection group had a successful therapeutic response after 3 months. Conclusions: Corticosteroid injection and extracorporeal shockwave therapy are successful treatment modalities for plantar fasciitis. Corticosteroid injection treatment is cost effective compared with extracorporeal shockwave therapy, and corticosteroid injection may be the first treatment choice according to these results. (J Am Podiatr Med Assoc 100(2): 105-110, 2010)Öğe A comparison of intrathecal sufentanil combined with either hyperbaric bupivacaine or hyperbaric ropivacaine for cesarean deliveries(2006) Hayit, Feray; Demiraran, Yavuz; Sezen, Gülbin; Kocaman, Buket; Iskender, Abdulkadir; Özdemir, IsmailObjective: In this study, we aimed to compare the motor and sensorial block characteristics, maternal and fetal effects, of intrathecal sufentanil combinations including either hyperbaric bupivacaine or hyperbaric ropivacaine in pregnant women undergoing spinal block for elective cesarean deliveries. Method: Sixty pregnant women between 18 and 40 years undergoing elective cesarean section were studied in a randomized prospective design. In group HBS, 12.5 mg hyperbaric bupivacaine and 5 ?g sufentanil in 3 mL serum physiologic was applied intrathecally in 30 of the women. In group HRS, 12.5 mg hyperbaric ropivacaine and 5 ?g sufentanil in 3 mL serum physiologic was applied intrathecally to the other 30. Results: In group HRS, the duration for reaching the maximum sensorial block was shorter in comparison to group HBS, although the difference was not statistically significant. The two-segment regression time was shorter in group HRS, when compared to group HBS. Motor block development time and motor block recovery time were statistically shorter in group HRS (p<0.05). Conclusion: Sufentanil combinations with either intrathecal hyperbaric bupivacaine or intrathecal hyperbaric ropivacaine can be used safely on patients undergoing cesarean deliveries.Öğe Comparison of sevoflurane and halothane on induction and recovery in pediatric patients(2004) Şerifsoy, T. Ercan; Demiraran, Yavuz; Çelikel, Nuran; Kocaman, BuketIn this study, the effects of sevoflurane and halothane on induction and emergence and were compared. The study enrolled 60 ASA I-II pediatric patients aged between 0-12 years. They received no premedication and were randomized into two groups, one of which received sevoflurane anesthesia (S) and the other halothane anesthesia (H). Each of these volatile anesthetics were adminisrated in 33% oxygen and 67% nitrous-oxide mixture, in increasing doses. When the eye-lash reflex disappeared, the volatile anesthetic concentration was kept constant for four and a half minutes to complete the induction of anesthesia, until the patients were intubated. Following intubation, the volatile anesthetic dose was reduced to 1-1.5 MAC for maintenance. At the end of the surgical procedure, all volatile anesthetics were stopped and 100% oxygen was administrated. During induction, the time between the beginning of the administration of the volatile anesthetic to the patient and the loss of the eye-lash reflex was recorded. During recovery, the time between the beginning of application of 100% oxygen and the first swallowing reflex, the first leg-pulling, the extubation time and the time of crying were noted. There were statistically significant difference the first leg-pulling times between the two groups. Laryngospasm was observed in two patients in Group H, vomiting was observed in one patient in Group H and 3 patients in Group S. The utilisation of sevoflurane in the pediatric patiens may be safer than halothane in terms of having shorter recovery time and no laryngospasm during the induction.Öğe A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children(Elsevier Sci Ltd, 2005) Demiraran, Yavuz; Kocaman, Buket; Akman, Ramazan YavuzBackground. The aim of this study was to compare epidural administration of single-dose tramadol with morphine in children undergoing urological surgery with respect to preoperative haemodynamic effects, postoperative analgesia and side-effects. Methods. Eighty children aged between 7 and 14 undergoing urological surgery were included in the study. After intubation, in the lateral decubitus position, a single dose of morphine 0.1 mg kg(-1) in isotonic saline 0.2 ml kg(-1) (morphine group) and tramadol 2 mg kg(-1) in isotonic saline 0.2 ml kg(-1) (tramadol group) was administered epidurally. During the 24-h postoperative period, heart rate, systolic blood pressure, respiration rate, pain score and sedation level of the patients were monitored. A modified objective pain score of 3 or lower was accepted as an indicator of inadequate analgesia and these patients were given 20 acetaminophen mg kg(-1) rectally or orally. Time to first analgesia was noted. Sedation level was evaluated with a four-point sedation scale. Results. In the postoperative period, pain scores and the average time for analgesic requirement were similar in the two groups. However, the incidences of allergic rash, itching, sedation and respiratory depression and sedation score were greater in the morphine group than in the tramadol group. Conclusion. Greater epidural use of tramadol may be preferred to morphine for postoperative analgesia under these circumstances.Öğe Complex regional pain syndrome type I: Efficacy of stellate ganglion blockade(2009) Yücel, İstemi; Demiraran, Yavuz; Özturan, Kutay; Değirmenci, ErdemBackground: This study was performed to evaluate the treatment of complex regional pain syndrome (CRPS) type I with stellate ganglion blockade. Materials and methods: We performed three blockades at weekly intervals in 22 patients with CRPS type I in one hand. The patients were divided into two groups depending on the time between symptom onset and treatment initiation. Group 1and 2 patients had short and long symptom-onset-to-treatment intervals, respectively. Pain intensity, using a visual analog score (VAS), and range of motion (ROM) for the wrist joint were assessed before and 2 weeks after treatment and were compared using nonparametric statistical analysis. Results: Treatment produced a statistically significant difference in wrist ROM for all patients (P < 0.001). VAS values showed an overall decrease from 8 ± 1 to 1 ± 1 following treatment, and there was a significant difference in VAS value between groups 1 and 2 (P < 0.05). Conclusions: We concluded that stellate ganglion blockade successfully decreased VAS and increased ROM of wrist joints in patients with CRPS type I. Further, the duration between symptom onset and therapy initiation was a major factor affecting blockade success. © 2009 Springer-Verlag.Öğe Deksmedetomidinin hemodinamik yanıt,laringoskopi ve endotrakeal entübasyon kalitesine etkisinin değerlendirilmesi(2007) Demiraran, Yavuz; Sezen, Gülbin; Özer, Elif; Kocaman, Buket; Iskender, AbdulkadirAmaç: Çalışmamızda premedikasyon amacıyla kullanılan deksmedetomidinin entübasyon kalitesine, nöromusküler monitörizasyon kullanarak kas gevşemesine ve hemodinamik yanıtlar üzerine olan etkilerinin değerlendirilmesi amaçlandı. Yöntem: Çalışmaya 18-55 yaş arasında toplam 48 hasta alındı. Grup D'ye 10 dakika 0.7 mcg kg'saat'1 hızda deksmedetomidin infüzyonu, Grup K' da ise serum fizyolojik infüzyonu verildi. İndüksiyon öncesi ve sonrasında nöromusküler monitörizasyon yapılarak değerler kaydedildi. Entübasyon kalitesi, çene gevşemesi, laringoskopiye direnç, vokal kord pozisyonu, vokal kord hareketleri, gövde hareketi ve diyafragma reaksiyonu anesteziyolog tarafından üçlü skala (1-harika, 2=iyi, 3-kötü) ile değerlendirildi. Eş zamanlı olarak ortalama kan basıncı ve kalp atım hızı değerleri kaydedildi. Bulgular: İndüksiyon ve kas gevşetici sonrası, grup K'nın ortalama kan basıncı değerleri grup D'ye oranla anlamlı olarak düşüktü (p<0.05). Grup D'nin kalp atım hızı değerleri, grup K'ya oranla premedikasyonun 4, 5, 6, 7, 8, 9, 10. dk'larında ve indüksiyon sonrası,, kas gevşetici sonrası anlamlı olarak düşük, entübasyon sonrasındaki 1,2 ve 5. dk'larda ise anlamlı olarak yüksekti. Entübasyon kalitesi ve kas gevşemesi açısından değerlendirme parametreleri karşılaştırıldığında gruplararası anlamlı fark yoktu. Sonuç: Bu çalışmada deksmedetomidinin entübasyon kalitesi ve kas gevşemesi üzerine olumlu bir etkisinin olmadığı, entübasyon sonrasındaki hemodinamik yanıtı baskıladığı gözlendi.Öğe Does topical lidocaine with adrenaline have an effect on morbidity in pediatric tonsillectomy?(Elsevier Ireland Ltd, 2005) Egeli, Erol; Harputluoğlu, Uğur; Oğhan, Fatih; Demiraran, Yavuz; Güçlü, Ender; Öztürk, ÖzcanObjective: To evaluate the efficacy of lidocaine with adrenaline on post-operative morbidity in pediatric patients after tonsillectomy. Study Design: A double blind prospective randomized controlled clinical study. Methods: The study is consisting of two groups of pediatric patients following tonsillectomy performed in a university hospital. One group received lidocaine with adrenaline soaked swabs packed in their tonsillar fossae white the control group received saline-soaked swabs. Chi-square and two-tailed unpaired Student's t-tests were used to compare the two independent groups. p < 0.05 was accepted as statistically significant. Results: No significant pain-relieving effect was seen in the lidocaine with adrenaline group (p > 0.05) and also the other post-operative parameters such as nausea, fever, vomiting, odor, bleeding, otalgia and trismus were not statistically different between the two groups based on chi-square analysis (p > 0.05). There were no complications associated with lidocaine and adrenaline. Conclusion: We suggest that application of topical lidocaine with adrenaline seems to be a safe and easy medication for local anesthetic use. However, in our study, lidocaine with adrenaline offered no advantage over placebo in the control of post-operative pain and other morbidity related factors following pediatric tonsillectomy. We therefore do not recommend topical application of lidocaine with adrenaline for reducing morbidity in pediatric tonsil surgery.Öğe Does tramadol wound infiltration offer an advantage over bupivacaine for postoperative analgesia in children following herniotomy?(Wiley, 2006) Demiraran, Yavuz; İlçe, Zekeriya; Kocaman, Buket; Bozkurt, PervinBackground : It has been demonstrated that tramadol is an effective analgesic. We aimed to compare postoperative analgesic effects of wound infiltration with tramadol (T) or bupivacaine (B) and intramuscular tramadol (I) after herniotomy in children. Methods: In this study, 75 children were randomly assigned to group T, group B and group I. Wound infiltration was performed to the patients in group T (2 mg.kg(-1) tramadol in 0.2 ml.kg(-1) saline) and group B (0.2 ml.kg(-1) 0.25% bupivacaine) into the surgical incision. Twenty minutes before the end of the surgery 2 mg.kg(-1) tramadol was injected i.m. in group I. Faces pain scale was used for assessing pain severity. Patients with pain score > 2 were treated with paracetamol. The frequency of side effects and analgesic use were recorded. Patients were discharged on the next day. Results: No side effects were recorded in any group. The pain scores of the patients at the first, fourth and eighth hours were significantly higher in group B and group I than group T (P < 0.05). The pain scores of the patients at the first hour were significantly higher in group I compared with group B (P < 0.05). Average time to first analgesic requirement was significantly longer in group T (6.72 +/- 4.09 h after herniotomy than both group I (4.49 +/- 3.9 h) and group B (6.04 +/- 3.7 h) (P < 0.05). Conclusions: Wound infiltration with tramadol may be a good choice for postoperative analgesia in children having inguinal herniotomy.Öğe Early enteral and glutamine enriched enteral feeding ameliorates healing of colonic anastomosis: Experimental study(Turkish Association of Trauma and Emergency Surgery, 2006) Gökpinar, Ibrahim; Gürleyik, Emin; Pehlivan, Mevlut; Özcan, Ömer; Özaydin, Ismet; Aslaner, Arif; Demiraran, YavuzBACKGROUND: To investigate the effects of postoperative early enteral and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis. METHODS: Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at the distal left colon was performed on all animals. Animals in groups 1 and 2 received late total enteral nutrition (TEN) and in groups 3 and 4 early TEN. Glutamine was added to TEN protocol in groups 2 and 4. The colonic segment including the anastomosis was excised at the end of the 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined. RESULTS: Bursting pressure levels were 111.6 and 95.8 centimeters of water (cmH2O) in early and late nutrition groups, respectively (p=0.022). Comparison of late TEN groups showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cmH2O; p<0.0001). Highest bursting pressures (139 and 138.5 cmH2O) were measured in both early and late TEN groups with glutamine. Tissue hydroxyproline level in early TEN group (2440.3 ?g) was significantly higher than late TEN group (1509.6 ?g; p=0.024). Comparison of late TEN groups showed a considerable but not statistically significant difference (p=0.276) in favor of group with glutamine (1509.6 vs 1981.6 ?g). CONCLUSION: Postoperative early TEN significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses the disadvantages of late TEN regarding the resistance of anastomosis. A similarly positive, albeit weaker, effect of glutamine supplementation is also seen on collagen synthesis.Öğe Effect of chronic obstructive pulmonary disease on washout time of sevoflurane anesthesia: a placebo controlled randomized trial(E-Century Publishing Corp, 2016) Şeker, İlknur Suidiye; Demiraran, Yavuz; Haftacı, Engin; Cangür, Şengül; Sezen, Gülbin; Karagöz, İbrahimBackground: Respiratory functions and gas exchange deteriorates in patients with COPD. In our study, we aimed to investigate if there is any relationship between the washout time of sevoflurane and chronic obstructive pulmonary disease (COPD). Method: Sixty patients, American Society of Anesthesiology (ASA) 1-3 status; aged between 18-60 years old who underwent general anesthesia for an operation were enrolled in our study. Patients were divided into two groups: Group N (non-COPD n = 33), group COPD (patients with COPD, n = 33). Two patients were excluded from the study, a total of 31 patients in Group COPD. Pre-operative respiratory function tests were performed and standard monitoring was provided in the operation room. Both groups received propofol 2 mg/kg, fentanyl 1.5-2 mcg/kg and rocuronium 0.6 mg/kg intravenously, and an oxygen-air mixture of 50%/50% with a tidal volume of 6 ml/kg (ideal body weight) and sevoflurane of 1 MAC. Remifentanil was administered at 0.05-0.1 mcg/ kg/min intravenously in the maintenance of anesthesia. All patients were monitored by an anesthesia machine until extubation. A sevoflurane vaporizer was closed at the end of the operation and the measurement time was started. FiO2, Fi(ins), Fi(exp) of sevorain, End-tidal CO2 were recorded during the operation and Fins (Sevo)/Fexp (Sevo) ratio, MAC1, MAC2, MAC3, MAC4, extubation times were recorded. Fi(ins)1: percentage of sevorain filiation in inspirium before closing 1 MAC vaporizer. Fi(exp)1: percentage of sevorain filiation in expirium before closing 1 MAC vaporizer. Fi(ins)2: percentage of sevorain filiation in inspirium after closing 0.1 MAC vaporizer. Fi(exp)2: percentage of sevorain filiation in expirium after closing 0.1 MAC vaporizer. Results: There was no significant relationship between the respiratory function tests of individuals with or without COPD and MAC1, MAC2, MAC3, MAC4 and extubation time (P > 0.05). The cut-off criterion for MAC4 was determined to be 210 seconds. Conclusion: Although there was no difference between the washout and extubation times of both groups, increased BMI and decreased intraoperative hemoglobin values should be carefully considered during anesthetic management in the COPD group.Öğe Effect of ketamine anaesthesia on middle ear pressure in rabbits: A pilot study(2006) Kocaman, Buket; Öztürk, Özcan; Demiraran, Yavuz; Ağartan, Canan Aldırmaz; Egeli, ErolObjectives: Although most studies about effect of anaesthetics on middle ear pressure were explained with gas effect there are no studies about effect of ketamine on middle ear pressure. The aim of this study was to evaluate the effect of ketamine anaesthesia on middle ear pressure. Methods: Male New Zealand rabbits (n=15), weighing between 2.5-3.2 kg were randomly divided into two groups. Those in Group I (n=9) were anaesthetized by intravenous ketamine 50 mg.kg-1 whilst Group II (n=6) were injected with the same volume of saline. Baseline tympanometry readings were performed on the left and right ears after otoscopy examination and again at 5 and 20 minutes. Results: The change of tympanometric measurements before ketamine, at 5th and 20th minutes of the administration was no statistically significant in both of Group I and II (p>0.05). There was a slightly significant difference at 20th min of administration when ketamine group compared with control group (-55.6±29.5 in Group I; -29.0±33.5 in Group II) (p=0.03). Conclusion: In this study it is concluded that ketamine anaesthesia has no effect on the pressure in middle ear.Öğe Effects of sevoflurane and TIVA with propofol on middle ear pressure(Elsevier Ireland Ltd, 2006) Öztürk, Özcan; Demiraran, Yavuz; İlçe, Zekeriya; Kocaman, Buket; Güçlü, Ender; Karaman, EminObjective: To evaluate the effects of sevoflurane and TIVA with propofol on middle ear pressure and to show the importance of anesthesia without using any inhalational agents during middle ear surgery. Study design: A prospective, randomized controlled clinical study. Methods: In this study, 25 male children that were scheduled for circumcision were randomised into two groups. Group I (n = 13) received TIVA with propofol and group II (n = 12) received sevoflurane. Baseline tympanometry reading was performed on each ear just before anesthesia. The next tympanometry reading was taken 10 min after applying the laryngeal mask. Data were analysed by Mann-Whitney U (between groups) and Wilcoxon tests (within groups). Results: Mean MEP values in 26 ears of 13 boys in group I did not show any significant difference before and after the anesthesia with propofol (p > 0.05). In group II mean MEP values in 24 ears of 12 boys showed a significant increase after the anesthesia with sevoflurane (p < 0.001). No significant difference was found between the MEP values of the two groups before the anesthesia (p > 0.05), and MEP values measured during the anesthesia were significantly higher in group II (p = 0.007). Conclusion: Sevoflurane may increase the middle ear pressure and TIVA with propofol may be used in middle ear operations more safely than sevoflurane.Öğe The effects of topical levobupivacaine on morbidity in pediatric tonsillectomy patients(Elsevier Ireland Ltd, 2009) Yilmaz, Sueleyman; Demiraran, Yavuz; Akkan, Nermin; Yaman, Hueseyin; Iskender, Abdulkadir; Guclu, Ender; Ozturk, OzcanObjective: To reduce the post-tonsillectomy morbidity by swab soaked with 5 ml levobupivacaine hydroclorur (25 mg/10 ml). Study design: A double-blind prospective randomized controlled clinical study. Methods: In this randomized double-blind study in group I (30 children, mean age 7.5 +/- 2.6) we tightly packed swab soaked with 5 ml levobupivacaine hydroclorur (25 mg/10 ml) and in group II (21 children, mean age 7.9 +/- 3.7) we used 5 ml saline swabs into each of the two tonsillar fossae after tonsillectomy for 5 min. We used McGrath's face scale to compare the two groups in respect of pain control. Results: There was statistically significant pain relieving effect in the levobupivacaine group in the first 24 h (p < 0.05). But after 24 h pain relieving effect of levobupivacaine was not significant (p > 0.05). We did not see any serious complications for both groups. Postoperative morbidity mean results (nausea, vomiting, fever, bleeding, halitosis and ear pain) were not statistically different between the two groups (P > 0.05). Conclusion: Topical levobupivacaine seems to be a safe and easy medication for postoperative pain control in pediatric tonsillectomy patients. (c) 2009 Elsevier Ireland Ltd. All rights reserved.Öğe Elektif sezaryen girişimlerinde intratekal hiperbarik bupivakain ile ropivakain'e eklenen sufentanil'in karşılaştırılması(2006) Hayıt, Feray; Demiraran, Yavuz; Sezen, Gülbin; Kocaman, Buket; İskender, Abdulkadir; Özdemir, İsmailAmaç: Bu çalışmada elektif sezaryen için sufentanil eklenen hiperbarik ropivakain ve bupivakain kombinasyonlarının intratekal verilmesinin motor ve duyusal blok özellikleri, anne ve bebek üzerine etkilerinin karşılaştırılması amaçlandı. Yöntem: Çalışma, ASA I-II, 18-40 yaşları arasında elektif sezaryen operasyonu geçirecek miadında 60 gebe kadında, prospektif ve randomize olarak planlandı. İntratekal olarak 30 gebeye 12.5 mg hiperbarik bupivakain+5 pıg sufentanil 3 mL serum fizyolojik içinde (Grup HBS) ve diğer 30 gebeye de 12.5 mg hiperbarik ropivakain+5 pıg sufentanil 3 mL serum fizyolojik içinde (Grup HRS) kullanıldı. Bulgular: HRS grubunda, HBS grubuna göre maksimum duyusal bloğa ulaşma süresi istatistiksel olarak anlamlı çıkmasa da daha kısa idi. İki segment regresyon süresi HRS grubunda, HBS grubundan daha kısa bulundu. Gruplar arası karşılaştırmada motor blok oluşma süresi ve motor blok kalkış süreleri HRS grubunda anlamlı daha kısa idi (p<0.05). Sonuç: Sezaryen ile gerçekleştirilen doğumlarda, intratekal hiperbarik bupivakain ve hiperbarik ropivakaine sufentanil ilavesinin güvenle kullanılabileceği kanısına varılmıştır.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 Erken enteral ve glutaminli enteral beslenmenin kolon anastomoz iyileşmesine etkisi: Deneysel çalışma(2006) Gökpınar, İbrahim; Gürleyik, Emin; Pehlivan, Mevlüt; Özcan, Ömer; Özaydın, İsmet; Aslaner, Arif; Demiraran, YavuzAMAÇ Ameliyat sonrası total enteral beslenmenin (TEB) erken uygulanmasının ve beslenmeye glutamin eklenmesinin deneysel kolon anastomoz iyileşmesine etkisi araştırıldı. GEREÇ VE YÖNTEM Çalışmada 40 Wistar-albino sıçan eşit sayıda denek içeren 4 gruba ayrıldı. Deneklere distal sol kolon transseksiyonu ve anastomozu uygulandı. Grup 1 ve 2’ye geç TEB; grup 3 ve 4’e erken TEB uygulandı. Grup 2 ve 4’te beslenmeye glutamin eklendi. Ameliyat sonrası yedinci günün sonunda anastomoz içeren kolon segmenti çıkarılarak anastomoz patlama basıncı ve doku hidroksiprolin değerleri belirlendi. BULGULAR Anastomoz patlama basıncı erken grupta 111.6, geç grupta 95.8 cmH2O bulundu (p=0.022). Geç TEB grupları arasında glutaminli grup lehine anlamlı fark saptandı (95.8’e 138.5 cmH2O; p<0.0001). Gerek erken, gerekse geç glutaminli TEB’in uygulandığı gruplarda en yüksek patlama basıncı değerleri elde edildi (139 ve 138.5 cmH2O). Doku hidroksiprolin miktarı, erken (2440.3 µg) ve geç (1509.6 µg) TEB grupları arasında anlamlı farklı bulundu (p=0.024). Geç enteral beslenme grupları karşılaştırıldığında glutaminli grup lehine anlamlı olmamakla (p=0.276) birlikte sayısal fark saptandı (1509.6 ya 1981.6 µg). SONUÇ Ameliyat sonrası dönemde TEB’in erken uygulanması anastomoz direnci ve kollajen sentezini anlamlı olarak desteklemektedir. Anastomoz direnci açısından geç TEB uygulandığı durumda beslenmeye glutamin eklenmesi, geç beslenme olumsuzluklarını azaltmakta ve geri döndürmektedir. Glutaminin benzer olumlu etkisi daha zayıf olmakla birlikte kollajen sentezi üzerinde de görülmektedir.Öğe Evaluation of the effectiveness of fentanyl, tramadol and diclofenac in combination with propofol for dilation and curettage(Galenos Yayincilik, 2006) Demiraran, Yavuz; Somunkiran, Asli; Sezen, Gulbin; Kocaman, Buket; Hayit, Feray; Ozdemir, IsmailObjective: To compare the value of three agents in terms of providing postoperative analgesia in patients having dilation and curettages. Their effects on hemodynamic parameters were evaluated. Recovery and sedation properties were also assessed. Design: Prospective, randomized trial Setting: University hospital Patients: Sixty three patients who underwent fractional curettage. Interventions: Diclofenac 1 mg/kg intramuscularly 30 minutes before induction and tramadol 1 mg/kg intravenously 15 minutes before induction were given in group 1 and 2, respectively. The third group received fentanyl 1 mu g/kg intravenously for induction. Then, induction was provided with propofol 2 mg/kg and % 50 air and % 50 oxygen given with face mask. For anesthesia management 20% of the induction dose of propofol was used intermittently. Main outcome measures: Peroperative and postoperative haemodynamic parameters and SPO2 were recorded. Visual Analog Scale 0-10 cm, sedation score 0-4 point, Aldrete recovery scores 1-10 were assessed postoperatively at the 1, 5, 15, 30, and 120th minutes. Results: Peroperative and postoperative hemodynamic parameters showed no difference. The scores obtained by using Visual Analog Scale were also similar in all groups. There were no differences in sedation and Aldrete recovery scores in the three groups. On the other hand, propofol consumption was significantly lower in the fentanyl group when compared with the other two groups. Conclusion: Fentanyl usage decreased the amount of propofol when compared with diclofenac and tramadol administration. However, both tramadol and diclofenac were associated with lower amount of supplementary analgesic agents. They are both nonnarcotic analgesics. Therefore, preference of these two agents may be regarded more favorable.
