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    CNS Toxicity after Combined Sciatic and Femoral Nerve Block with Lidocaine
    (2004) Özcan, Ş.; Apan, Alparslan; Büyükkoçak, Ü.; Başar, H.; Erdemoğlu, Ali Kemal
    Combined sciatic-femoral nerve block was performed in a 48-year-old woman for the removal of a right lateral malleolar lesion. The patient became unconscious at the 12th minute of the block. As vital signs were stable and no additional complication was seen, the operation was carried out and completed. The patient began to respond to painful stimulus, and was conscious and fully oriented. 95 and 135 minutes after the block respectively. Although the patient's symptoms were not consistent with classical central nervous system toxicity, relatively high dose of lidocaine used, and coexistence of anemia, occurrence of muscular twitching which could be related to seizure activity, and the treatment of this twitching with a small dose of midazolam were thought to indicate toxicity.
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    The Effects of Combination of Verapamil and MK-801 on Rat Neuropathic Pain Model
    (2003) Özcan, Ş.; Apan, Alparslan; Gültekin, Sena
    N-methly-D-aspartae receptor is activated by calcium. The effects of a calcium antagonist verapamil and N-methly-D-aspartae receptor antagonist MK-801 on thermal nociception in rat model of chronic nerve injury was well known. We aimed to study the analgesic effects of combination of two drugs using the same model. The present study was constituted on 30 male Sprague Dawley rat weighing 180-220 g. The right common sciatic nerve was exposed and ligated loosely with 4/0 chromic gut under anaesthesia with a barbiturate. The administration of drugs were started after the operation and continued through five days. According to the treatment protocol, verapamil 10 mg kg -1 was administered for four days and on the fifth day MK-801 1 mg kg -1 was combined. The drugs were given with 20 minutes' intervals through intraperitoneal route. Nociceptive tests were performed by Hot Plate Test at 46.5°C throughout a 120 minutes' period at every 30 minutes. The time of withdrawal of the operated limb was accepted as reaction time. Chronic administration of verapamil or MK-801 administration as a sole drug was substantially reduced nociception on neuropathic pain model. The antinociceptive effects of the combination of drugs was found to be lower than values obtained from each drug individually. Pretreatment with a calcium antagonist reduced the sensitivity to N-methyl-D-aspartate receptor on neuropthic pain model. It was concluded that, the binding sites of calcium antagonists and MK-801 on N-methyl-D-aspartate receptors can be close to each other, therefore antagonism may be seen by reducing receptor sensitivity or a reaction during binding.
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    Ketamine abolishes cyclohexyladenosine induced antinociception on mononeuropathic rats
    (2002) Apan, Alparslan; Özcan, Ş.; Başar, H.; Büyükkoçak, Ünase
    Ketamine is known as a N-Methyl-D-Aspartate (NMDA) antagonist. Purine analogues attenuate pain transmission and also act as glutamate antagonists. The aim of the present study was to determine the antiallodynic effect of adenosine A1 receptor agonist, cyclohexyladenosine (CHA) and ketamine on thermal nociception in chronic constriction injury model in the rat. The present study was constituted on 32 male Sprague Dawley rats weighing 180-220 g. The right common sciatic nerve was exposed and ligated loosely with 4/0 chromic catgut under barbiturate anaesthesia. Drugs were administered after 7th postoperative day and given through four days. Treatment protocol was two injections/day performed by a 20 min interval through intraperitoneal route. Adenosine analogues were administered as the first drug. Doses were 1 mg/kg and 10 mg/kg for CHA and ketamine respectively. Doses were reduced to half when both of drugs were combined. Nociceptive tests were performed by Hot Plate Test (HPT) at 46°C through 120 min period every 30 minutes. Initiation time of jumping and licking movements at the operated side of the rats on the HPT was determined. Motor activity were increased on animals that received ketamine. Adenosine receptor analogue CHA clearly produced antinociception. Ketamine abolished CHA induced analgesia. The results were disappointing, antagonism was observed by two class of drugs known as glutamate antagonist and can be explained by excitatory phenomenon induced by ketamine. Future studies directed at other routes may show promise.