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Öğe Bir lomber diskektomi olgusunda epidural anestezi: Olgu sunumu(2003) Kocaman, Buket; Oruç, Abdülkadir; Boztepe, Ayşenur; Büyükkömürcü, Ibrahim; Özkan, Hüseyin; Arikan, ZuhalEpidural anestezi bazı merkezlerde lomber disk cerrahisinde uygulanmaktadır. Rejyonel anestezinin genel avantajlannın yanı srra, bu teknik beyin cerrahının hasta ile sözlü iletişim kurarak sinir basısının olduğu bölgeyi saptamasında yardımcıdır. Lomber disk cerrahisinde epidural anestezi uygulaması, iyi sonuçlar ve uzun süreli postoperatif analjezi sağlayan emniyetli ve yararlı bir yöntemdir. Biz lomber disk cerrahisi için epidural anestezi uygulanan bronşiyal astımı olan bir olguyu sunmaktayız. Lomber disk cerrahisinde epidural anestezi uygulamasını tartışmayı ve hatırlatmayı amaçlıyoruz.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 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 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 Dilatasyon ve küretajda propofol ile birlikte kullanılan tramadol, diklofenak ve fentanil’in etkinliklerinin karşılaştırılması(2006) Demirakan, Yavuz; Somunkıran, Aslı; Sezen, Gülbin; Kocaman, Buket; Hayıt, Feray; Özdemir, İsmailObjektif: Küretaj operasyonlarında postoperatif ağrı, derlenme ve sedasyon düzeyi ile intravenöz anestetik ilaç kullanımı ve hemodinamiye etkileri açısından diklofenak, tramadol ve fentanilin karşılaştırılması amaçlandı. Planlama: Randomize prospektif klinik çalışma. Ortam: Üniversite hastanesi Hastalar: Fraksiyone küretaj planlanan 63 hasta Girişim: Hastalar 3 gruba ayrıldı. Grup 1’de indüksiyondan 30 dk önce im diklofenak 1 mg/kg, grup 2’de indüksiyondan 15 dk önce iv tramadol 1 mg/ kg, grup 3’de indüksiyonda iv fentanil 1 μg/ kg dozunda uygulandı. İndüksiyon için propofol 2 mg/ kg ile yüz maskesi uygulanarak % 50 hava ve O2 ile devam edildi, idame ihtiyacı olduğunda propofol indüksiyon dozunun % 20 si olarak tekrarlandı. Değerlendirme Parameteleri: Peroperatif ve postoperatif SKB, DKB, OKB, KAH ve SpO2 kaydedildi. Postoperatif olarak 1, 5, 15, 30 ve 120. dakikalarda; Visual Analog Skala 0-10 cm, sedasyon skoru 0-4 puan, Aldrete derlenme skoru 1-10 puan arasında değerlendirildi. SONUÇ: İndüksiyon için fentanil kullanılan grupta indüksiyon öncesi tramadol ya da diklofenak kullanılan gruplara göre anlamlı olarak daha az propofol ihtiyacı izlendi ( p= 0.012 ve p=0.013). YORUM: Fentanil kullanımı, tramadol ve diklofenak kullanımına göre propofol tüketimini azaltmıştır. Buna rağmen, postoperatif ek analjezik ihtiyacının daha az olması ve narkotik analjezik olmamaları nedeniyle tramadol ve diklofenak’ın daha avantajlı olduğunu düşünmekteyiz.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 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 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 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.Öğe Intrathecal sufentanil (1.5?g) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy(2006) Demiraran, Yavuz; Özdemir, İsmail; Kocaman, Buket; Yücel, OğuzPurpose: We compared the effects of different doses of intrathecal sufentanil when administered together with hyperbaric bupivacaine for elective caesarean section. Methods: This was a prospective, randomized, double-blind, controlled trial involving 100 pregnant women, American Society of Anesthesiologists (ASA) I-II, who were scheduled for elective caesarean section under spinal anesthesia. The patients were assigned to four groups according to the dose of sufentanil used: no sufentanil (group I; placebo) or 1.5, 2.5, or 5.0?g sufentanil (groups 2-4, respectively). In every group, the local anesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg), and the total volume of the solution was 3.5 ml. The duration of complete analgesia, maternal side effects, and maternal/ fetal outcomes were recorded. The duration of complete analgesia was defined as the time from intrathecal injection to a vernal analogue score (VAS) of more than 0. Results: No patient experienced intraoperative pain. The duration of complete analgesia was prolonged in all groups receiving opioids. The duration of the analgesia and the 0- to 6-h intravenous analgesic requirements were similar in the sufentanil groups. Moreover, the sufentanil groups had longer durations of complete analgesia than the placebo group. Pruritus was more frequent in the 2.5- and 5-?g sufentanil groups than in the 1.5-?g sufentanil and placebo groups. There were no differences among the groups in umbilical cord blood gases on in neonatal Apgar scores. Conclusion: The addition of sufentanil 1.5 and 2.5?g to hyperbaric bupivacaine provided adequate anesthesia for caesarean delivery and good postoperative analgesia. In addition, the incidence of pruritus was significantly lower in the 1.5-?g sufentanil group when compared with that in the 2.5- and 5-?g groups. © JSA 2006.Öğe Ölümle sonuçlanan diagnostik jinekolojik laparoskopi: Hekim kusurlu mu?(2005) Büken, Bora; Demiraran, Yavuz; Büken, Erhan; Kocaman, BuketTıbbi uygulama hatası iddiası tıbbın bütün alanlarını ilgilendirmektedir. Meydana gelen her kötü sonuç bir tıbbi hatadan kaynaklanmaz. Son yıllarda ülkemizde bir çok cerrahi girişimde laparoskopik cihazların kullanımı rutin olarak, yaygın bir şekilde kullanılmaya başlamıştır. Bu nedenle işlemin potensiyel riskleri ve komplikasyonları da göz ardı edilmemelidir. Çok nadir görülen komplikasyonlar bazen çok ciddi, hatta öldürücü olabilmektedir. Bu olgu sunumu endometriosis problemi olan 30 yaşındaki bir bayanda tanısal amaçlı karbondioksit insüflasyonu kullanılarak yapılan diagnostik laparoskopi sırasında ani gelişen kardiovasküler kollaps sonucu ölüm ve tıbbi uygulama hatası iddiasını içermektedir.Öğe Pediyatrik üroloji operasyonlarında epidural tramadol ve morfinin analjezik etkinliğinin karşılaştırılması(2003) Demiaran, Yavuz; Akman, Yavuz R; Kocaman, Buket; Erol, AliÇalışmamızda majör ürolojik (epispadiyas, hipospadiyas) ameliyat geçiren çocuklarda tek doz olarak epidural aralıktan yapılan morfin ile tramadolün peroperatif hemodinamik etkisi, postoperatif analjezik etkinliği ve yan etkileri karşılaştırıldı. Majör ürolojik ameliyat geçiren yaşları 3 ile 14 yıl arasında değişen toplam 40 çocuk çalışma kapsamına alındı. Entübasyonu takiben, lateral dekübitüs pozisyonu verildi. Bu pozisyonda epidural iğneyle epidural bölgeye Morfin (M) grubuna 0.1 mg/kg morfin 0.2 mL/kg serum fizyolojik içinde, Tramadol (T) grubuna ise 2 mg/kg tramadol 0.2 mL/kg serum fizyolojik içinde tek doz olarak verildi. Postoperatif dönemde 24 saat süresince kalp atım hızı (KAH), sistolik arter basıncı (SAB), solunum sayısı, ağrı skorları ve sedasyon düzeyi izlendi. Yüz skoru >= 3 yetersiz analjezi olarak kabul edilerek, 20 mg/kg parasetamol suppozituar ile tedavi edildi. İlk analjezik gereksinim zamanı kaydedildi. Sedasyon düzeyi; four-point sedasyon skorlaması ile 0-3 arasında puan verilerek değerlendirildi. Postoperatif dönemde, ağrı skorları, analjezik ihtiyaçları açısından gruplar arasında anlamlı bir fark gözlenmedi. Morfin grubunda bulantı, kusma, allerjik döküntü, sedasyon skorları ve solunum depresyonu, tramadol grubuna nazaran anlamlı fazla idi. Pediyatrik girişimlerde daha sıklıkla genel anestezi uygulanmasına rağmen, rejyonel anestezi, hem intraoperatif hem de postoperatif dönemde uygulanabilmekte, postoperatif dönemde solunum merkezlerinde depresyon yapmaksızın etkin analjezi ve erken mobilizasyon sağlanmaktadır. Epidural verilen morfin, tramadol'e nazaran daha fazla yan etkileri gözlendiğinden ağrı skorları arasında anlamlı fark olmadığı için tramadol'ün güvenle kullanılabileceğini düşünüyoruz.Öğe Sevofluran ve halotan ile indüksiyon ve derlenmenin pediatrik olgularda karşılaştırılması(2004) Şerifsoy, Talat Ercan; Demiraran, Yavuz; Çelikel, Nuran; Kocaman, BuketBu çalışmada çocuk yaş grubunda sevofluran ile halotanın; indüksiyon ve derlenme dönemlerine etkilerinin karşılaştırılması amaçlandı. Premedikasyon uygulanmamış ASA I-II grubu, 0-12 yaşları arasında 60 çocuk, randomize olarak halotan (n=30) (H) ve sevofluran (n=30) grubu (S) olmak üzere iki gruba ayrıldı. Volatil anestezik her bir gruba tedrici olarak artırılarak %33 oksijen-%67 azot-protoksit karışımı ile birlikte uygulandı. Kirpik refleksi kaybolduktan sonra, volatil anestezik maddenin konsantrasyonu değiştirilmeden dörtbuçuk dakikalık indüksiyon süresini tamamlayarak hastalar entübe edildi. Entübasyon sonrasında volatil anestezik konsantrasyonu 1-1.5 MAC'lık idame değerine düşürüldü. Operasyonun son sütürlerinin konmaya başlanmasıyla birlikte tüm anestetik maddeler kesilerek %100 oksijen uygulanmaya başlandı. Maske tutulmasından kirpik refleksinin kaybolması, uyanma sırasında ilk yutkunma refleksi, ilk bacak çekme, ekstübasyon zamanı ve ilk ağlamaya başlayıncaya kadar geçen süreler kaydedildi, iki grup arasında bacak çekme süreleri arasında anlamlı farklılık vardı. Laringospazm H grubunda iki hastada gözlendi, kusma H grubunda bir, S grubunda ise 3 hastada tespit edildi. Sevofluranın pediyatrik hastalardaki kullanımının, indüksiyon sırasında laringospazm gözlenmemesi ve derlenme sürelerinin daha kısa olması nedenleriyle halotana oranla daha güvenilir olduğu kanısına varıldı.Öğe Subanestezik konsantrasyonlarda solutulan desfluran ve sevofluranın sıçanlarda; karaciğer ve böbrek toksisitesi ile davranışları üzerine etkileri(2007) Sezen, Gülbin; Demiraran, Yavuz; Kocaman, Buket; Aksoy, K. AylinAmaç: Subanestezik konsantrasyonlarda anestezik gazlara kronik maruziyetin, ameliyathane personeli için zararlı olduğu birçok çalışmada gösterilmiştir. Bu çalışmadaki amacımız; desfluran ve sevofluranın subanestezik konsantrasyonlarda solutulmasının, sıçanların davranışları üzerine etkileri, karaciğer ve böbrek toksisiteleri ile biyokimyasal ve histopatolojik değişikliklerinin incelenmesiydi. Gereç ve Yöntem: Toplam 24 sıçan çalışmaya dahil edildi ve sevofluran (% 0.1), desfluran (% 0.04) ve kontrol (3 lt dk-1 O2) olmak üzere 3 gruba ayrıldı. Anestezi odasında, 4 ay süresince 09.00-13.00 saatleri arasında sıçanlar anestezik gazlara maruz bırakıldı. Anksiyete değerlendirmesi için Plus Maze Testi uygulandı; deney öncesi ve sonrasında kan örneklerinde üre, BUN, kreatinin ve GGT incelemeleri yapıldı. Deney bitiminde sıçanlar sakrifiye edilerek, karaciğer ve böbrekler histopatolojik olarak incelendi. Bulgular: Sevofluran grubunda GGT, üre ve BUN değerlerinde anlamlı artış gözlendi. Kapalı kollarda hareketsiz kalma süreleri, sevofluran ve desfluran grubunda anlamlı uzamış bulundu. Karaciğerde konjesyon, sevofluran ve desfluran grubunda kontrol grubuna göre anlamlı fazla bulundu, aynı zamanda sevofluran grubunda fokal nekroz diğer gruplardan anlamlı fazla gözlendi. Sevofluran grubunda, böbrekte fokal lenfositik infiltrasyon ve tubuler epitelde yassılaşma diğer gruplardan anlamlı fazla gözlendi. Sonuç: Bulgularımız incelendiğinde, sıçanlarda subanestezik konsantrasyonlarda sevofluran ve desfluran kullanımının anksiyeteyi arttırdığı ve bu konsantrasyondaki sevofluranın subklinik düzeyde böbrek ve karaciğerde hasara yol açabileceği sonucuna varıldı.Öğe Subanesthetic concentration of sevoflurane and desflurane were inhalated in rats; Liver and kidney toxicities and behavioural effects(2007) Sezen, Gülbin; Demiraran, Yavuz; Kocaman, Buket; Aksoy, K. AylinAim: Numerous studies have suggested that chronic exposure to trace levels of anesthetic gas is harmful to operating room personel. In this study, we aimed to the effects of subanesthetic doses of sevoflurane and desflurane on anxiety and hepatic and renal toxicities according to biochemical and histopathological changes in rats. Material and Methods: Total 24 rats were included study and three groups were formed as sevoflurane (% 0.1), desflurane (% 0.04) and control (3 L min -1 O 2). During four months, every day between 09.00-13.00 hours in the morning were inhaled with anesthetic agent determined concentrations. Anxiety were examined with Plus Maze Test; pre and post study urea, BUN, creatinine and GGT were examined in blood supplies. At the end of the study, rats were sacrificed for examined of kidney and liver histopathologically. Results: In the sevoflurane and desflurane groups increased the time spent within the closed pathways without motion. In the sevoflurane group; GGT, urea and BUN levels were elevated significantly. In the sevoflurane and desflurane groups hepatic congestion were examined significantly increased more than control group, focal necrosis increased in the sevoflurane group more than others. In the sevofluran group; focal lymphocytic infiltration and flatting in the tubuler epithelium were examined significantly higher than other groups. Conclusion: Our results were examined, subanesthetic doses of sevoflurane and desflurane were used increased to anxiety, caused of renal and hepatic damage at subclinic levels in rats.
