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Öğe The Comparison of Preemptive Analgesic Effectiveness of Epidural and Intravenous Fentanil(2003) Özcan, Şaziye; İnan, Nurten; Kaymak, Çetin; Ünal, NurtenIn this study, we aimed to compare the preemptive analgesic effect of fentanyl, which is used by intravenous or epidural route, in total abdominal hysterectomy (TAH). Fifty-four ASA I-II patients who admitted for total abdominal hysterectomy were included to this study and patients were randomly separated into three groups. All patients were given standard general anesthesia. General anesthesia alone was given in control group (Group K). In epidural analgesia group (Group E), epidural catheter was inserted preoperatively through L2-3 interspace and 4 ?g kg-I fentanyl in 10 mL0.9 % NaCl was administered 30 min. before incision. In intravenous analgesia group (Group I), fentanyl 4 ?g kg-1 was administered intravenously 5 min. before skin incision. Pain scores were assessed with visual analogue scale (VAS) at 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. First analgesic requirement time and total analgesic consumption were also recorded. Surgical stress response was evaluated with the blood glucose and plasma cortisol levels of patients whom were obtained before the incision and postoperative 4th hour. Compared to the other two groups, we observed that remarkable lower VAS pain scores and total analgesic consumption was provided in Group E (p<0.05). First analgesic requirement time was also significantly prolonged in Group E (p<0.05). The blood glucose and plasma cortisol levels at 4th hour postoperatively were significantly lower in Group E when compared to the other two groups (p<0.05). As a result we suggested that preemptive epidural fentanyl administration was more effective than preemptive intravenous fentanyl in postoperative acute pain and surgical stress response control at total abdominal hysterectomy.Öğe Effectiveness of eutectic mixture of local anesthetic cream and occlusive dressing with low dosage of fentanyl for pain control during shockwave lithotripsy(Mary Ann Liebert, Inc, 2005) Yilmaz, Erdal; Batislam, Ertan; Basar, M. Murad; Tuglu, Devrim; Özcan, Şaziye; Basar, HalilBackground and Purpose: To investigate the effect and usefulness of Eutectic Mixture of Local Anesthetic (EMLA) applied with an occlusive dressing and used simultaneously with a low dose of fentanyl during shockwave lithotripsy (SWL). Patients and Methods: One hundred sixty patients with kidney stones, aged between 19 and 68 years, were randomly, divided into seven groups that were treated as follows: group 1: fentanyl 1 mu g/kg by intravenous infusion (IV); group 2: IV fentanyl 0.25 mu g/kg; group 3: occlusive dressing and IV fentanyl 0.25 mu g/kg; group 4: placebo cream and IV fentanyl 0.25 mu g/kg; group 5: EMLA cream and IV fentanyl 0.25 mu g/kg; group 6: placebo cream and IV fentanyl 0.25 mu g/kg with an occlusive dressing; and group 7: EMLA cream and IV fentanyl 0.25 mu g/kg with an occlusive dressing. The mean arterial pressure (MAP), heart rate, ventilatory rate, and oxygen saturation (SpO(2)) were recorded on all patients. A visual analog scale 0-100 mm (VAS) was used for the evaluation of pain. The skin integrity was inspected to detect any lesions after SWL. Results: The SPO2 in group I was lower statistically than in the other groups. The VAS score in group 7 was clearly lower than in the others in the first, tenth, and twentieth minutes and at the end of SWL. In groups 6 and 7, additional fentanyl doses were lower than in the other groups, but only in group 7 was the total fentanyl dosage low. Skin lesions were not seen only in groups 3, 6, and 7. Conclusion: Use of EMLA and an occlusive dressing with low doses of fentanyl during SWL provides appropriate analgesia with minimal morbidity.Öğe Epidural ve intravenöz fentanilin preemptif analjezik etkinliğinin karşılaştırılması(2003) Özcan, Şaziye; İnan, Nurten; Kaymak, Çetin; Ünal, NurtenBu çalışmada, total abdominal histerektomilerde epidural ve intravenöz olarak uygulanan fentanilin preemptif analjezik etkinliğinin karşılaştırılması amaçlandı. ASA I-II grubu, total abdominal histerektomi yapılacak 54 hasta çalışmaya alındı ve randomize olarak üç gruba ayrıldı. Bütün hastalara standart genel anestezi uygulandı. Kontrol grubuna (Grup K, n18), sadece genel anestezi verildi. Epidural analjezi grubuna (Grup E, n18), preoperatif olarak L2-3 veya L3-4 aralıklarından yerleştirilen epidural kateterden 10 mL % 0.9 NaCl içinde 4 µg kg-1 fentanil, insizyondan 30 dakika önce uygulandı. İntravenöz analjezi grubuna (Grup İ, n18), insizyondan 5 dakika önce 4 µg kg-1 İV fentanil uygulandı. Postoperatif ağrı, 1.,2., 4., 6., 12. ve 24. saatlerde VAS ağrı skalası ile değerlendirildi. İlk analjezik istem zamanları ve 24 saatlik toplam analjezik tüketimleri kaydedildi. Ayrıca insizyon öncesi ve postoperatif 4. saatteki kan glukoz ve kortizol düzeylerine bakıldı. Postoperatif bütün evrelerdeki VAS skorları ve toplam analjezik gereksinimi Grup E'de diğer iki gruba göre anlamlı derecede düşük bulundu (p0.05). İlk analjezik istem zamanı da Grup E'de belirgin olarak uzundu (p0.05). Preinsizyonel kan glukoz ve kortizol değerlerinde gruplar arasında farklılık yok iken, postoperatif 4. saatte Grup E'de diğer iki gruba göre anlamlı derecede düşük bulundu (p0.05). Ancak bütün grupların postoperatif 4. saatteki değerleri preinsizyonel değerlerle karşılaştırıldığında, anlamlı bir artış tespit edildi (p0.05). Sonuç olarak total abdominal histerektomi ameliyatlarında preemptif epidural fentanilin akut postoperatif ağrı ve cerrahi stres yanıtın kontrolünde intravenöz fentanilden daha etkili olduğunu düşünmekteyiz.Öğe Lidokain ile siyatik-femoral sinir blokajı sonrası santral sinir sistemi toksisitesi(2004) Özcan, Şaziye; Apan, Alpaslan; Büyükkoçak, Ünase; Başar, Hülya; Erdemoğlu, Ali KemalSağ ayak lateral malleolünde lezyonu nedeni ile opere olacak 48 yaşındaki kadın hastaya kombine siyatik-femoral sinir blokajı uygulandı. Bloktan 12 dakika sonra bilinç kaybı meydana geldi. Ancak vital parametrelerin stabil olması ve ilave komplikasyon görülmemesi nedeni ile operasyona izin verildi. Bloğun 95. dakikasında hasta ağrılı uyaranlara cevap vermeye başladı ve bloktan 135 dakika sonra bilinci tamamen geri döndü. Hastanın semptomları klasik santral sinir sistemi bulguları ile uyumlu olmamakla birlikte; göreceli olarak yüksek doz lidokain kullanılmış olması, aneminin varlığı, nöbet aktivitesi olarak değerlendirilen kas seğirmelerinin olması ve bu kas seğirmelerinin düşük doz midazolam ile ortadan kalkması lokal anestezik toksisitesini düşündürdü.Öğe Local anesthesia in transrectal ultrasound-guided prostate biopsy: EMLA cream as a new alternative technique(Informa Healthcare, 2005) Basar, Hülya; Basar, M. Murad; Özcan, Şaziye; Akpinar, Serpil; Basar, Halil; Batislam, ErtanObjectives. The aims of the present study were to evaluate the efficacy of eutectic mixture of local anesthetics ( EMLA) cream in transrectal-guided prostate biopsy and to compare its effect with that of other injectable anesthetic procedures. Material and methods. Eighty male patients with prostate-specific antigen (PSA) levels >4 ng/ml or who had prostate nodules on digital rectal examination were randomly divided into four groups. In Group 1 ( controls), prostate biopsy was performed after application of a placebo cream. In Group 2, local surface anesthesia with EMLA cream was performed 15 min before biopsy. Periprosthetic nerve blockade was performed with 1% prilocaine and 1% lidocaine in Groups 3 and 4, respectively. Pain was evaluated using a visual analog scale (VAS) after each core biopsy. In addition, blood pressure, heart rate and oxygen saturations were recorded after each biopsy and then at 5-min intervals for 15 min. Results. Average VAS scores in Groups 1-4 were 5.5, 2.9, 2.4 and 2.2, respectively. There was a statistically significant difference in VAS scores between the treatment groups and the placebo group (p=0.000). There were no statistically significant differences in VAS scores between the three treatment groups (p(2-3) = 0.126, p(2-4) = 0.303, p(3-4) = 0.537). We detected no statistically significant differences between the groups based on the hemodynamic data (p(MAP) = 0.899). Moreover, these measurements did not show statistically significant changes with time in any of the groups (p > 0. 05). Conclusion. Intrarectal application of EMLA cream provides equal anesthesia to periprostatic nerve blockade with prilocaine and lidocaine.Öğe Postoperative prolonged apnea in weill marchesani syndrome(2003) Özcan, Şaziye; İnan, Nurten; Kaymak, ÇetinWeill Marchesani Sendromu (WMS), nadir, görülen bir sistemik konnektif doku hastalığıdır. Sendrom karakteristik olarak mikroseferofaki, ektopik lens, glokom, brakiodaktili ve brakiomorfı içermektedir. Bu olgu sunumunda, glokom cerrahisi geçiren, belirgin rezidüel blok ve postoperatif apne gelişen 17 ve 18 yaşlarında iki kız kardeş bildirilmektedir. Her iki hastamnda bir sonraki anestezi uygulamaları farklı anestezîk ajanlar kullanılarak sorunsuz tamamlanmıştır. Bu yazıda, uygulanan ilaçlar arasındaki muhtemel reaksiyonlar, konjenital sendrom ve uzamış apne nedenleri araştırılarak, tartışılmıştır.Öğe Preincisional infiltration of tonsils with ropivacaine in post-tonsillectomy pain relief: double-blind, randomized, placebo-controlled intraindividual study(B C Decker Inc, 2006) Arıkan, Osman Kürşat; Özcan, Şaziye; Kazkayasi, Mustafa; Akpinar, Serpil; Koç, CanObjective: To determine whether pre-emptive ropivacaine has an influence on postoperative pain in adult patients undergoing tonsillectomy. Design: A prospective, randomized, double-blind, placebo-controlled clinical trial. Setting: University hospital. Patients: The study included 20 adult patients undergoing elective tonsillectomy. Anesthetic induction and maintenance, dissection tonsillectomy, hemostasis techniques, and postoperative analgesic treatment were standardized for all patients. Before the onset of incision, one tonsillar fossa was administered 5 mL of 2% ropivacaine hydrochloride with epinephrine, whereas the other side received 5 mL of 0.9% saline with epinephrine and was designated as the control side. Main Outcomes Measures: For each side, postoperative pain, otalgia, operating time, amount of intraoperative blood loss, and postoperative hemorrhage were assessed. The intensity of postoperative pain was measured at rest and when the patient was drinking and was scored on a visual analogue scale. The patients were followed up for 10 days after surgery. Results: There was no statistically significant difference in the amount of intraoperative hemorrhage and operation time between sides (p >.05). The constant postoperative pain in the ropivacaine side at rest was significantly less than in the placebo side on days 1, 2, 5, and 6 (p <.05). The post-tonsillectomy pain experienced in the ropivacaine side when swallowing was significantly less than that in the placebo side throughout the study period except on day 10 (p <.05). Conclusion: Based on the present findings, preincisional infiltration of ropivacaine 2% appears to be effective against both early and late postoperative pain, especially on swallowing, following tonsillectomy in adults.Öğe Remifentanil ve fentanilin trakeal entübasyona bağlı hemodinamik yanıt üzerine etkilerinin karşılaştırılması(2003) Özcan, Şaziye; Başar, Hülya; Anbarcı, Özlem; Apan, Alpaslan; Büyükkoçak, Ünase; Çağlayan, OsmanGiriş: Laringoskopi ve trakeal entübasyonun sempato-adrenal yanıtı uyararak hemodinamik değişikliklere neden olduğu bilinmektedir. Bu çalışmada anestezi indüksiyonunda kullanılan fentanil ve remifentanilin, trakeal entübasyona bağlı stres yanıt üzerine etkilerinin karşılaştırılması amaçlandı.Hastalar ve Yöntem: Çalışmaya Amerikan Anesteziyoloji Derneğine (ASA) göre ASA I-II grubu, elektif cerrahi girişim uygulanacak 40 hasta dahil edildi. Hastalara anestezi indüksiyonu tiopental ve vekuronyum ile yapıldı. Anestezi idamesi ise %50 N2O/O2 karışımında % 2 sevofluran ile sağlandı. Rastgele iki gruba ayrılan hastalara anestezi indüksiyonunda 1. gruba fentanil (1 µg/kg), 2. gruba remifentanil (1 µg/kg) uygulandı. Hastaların indüksiyondan önce, indüksiyondan 2 dak sonra, entübasyondan 1 ve 5 dak sonra kalp atım hızı (KAH), ortalama arter basıncı (OAB) takibi yapıldı. Aynı evrelerde kan glukoz, serum kortizol, prolaktin ve büyüme hormonu (GH) düzeyleri değerlendirildi. Bulgular: Remifentanil grubu ile karşılaştırıldığında, fentanil grubunda KAH da entübasyon sonrası 1. (p 0,038) ve 5. (p 0.012) dakikalardaki artış, ile OAB da entübasyon sonrası 1. dakikadaki (p 0.047) artış anlamlı bulundu. Remifentanil grubunda entübasyon sonrası 1. dakikada prolaktin ve kortizol düzeylerinde anlamlı artış gözlendi, ancak bu artış fentanil grubuna göre belirgin olarak azdı (p0.043). Sonuç: Remifentanilin laringoskopi ve entübasyona bağlı hemodinamik yanıtı önlemede fentanile göre daha etkin olduğunu düşünmekteyiz.Öğe Sinonazal cerrahide farklı intravenöz sedasyon teknikleri(2003) Büyükkoçak, Ünase; Koç, Can; Özcan, Şaziye; Kaya, TahsinAmaç: Lokal anestezi altında uygulanan sinonazal cerrahide, intravenöz sedasyon için kullanılan dört farklı anestezik medikasyonun hemodinamiye etkileri ve yan etkileri karşılaştırıldı. Gereç ve Yöntem: Septoplasti veya fonksiyonel endoskopik sinüs cerrahisi geçiren seksen hasta, rastgele dört gruba ayrıldı. Birinci gruptaki hastalara midazolam (0,07 mg/kg) ve fentanyl (1 µg/kg/dk), intravenöz (İV), ikinci gruptaki hastalara fentanyl (1 µg/kg), İV ve propofol infüzyonu (2 mg/kg/sa), üçüncü gruptaki hastalara midazolam (0,07 mg/kg), İV ve remifentanil infüzyonu (0.05 µg/kg/dk), dördüncü gruptaki hastalara ise propofol (2 mg/kg/sa) ve remifentanil (0.05 µg/kg/dk) infüzyonu uygulandı. Bütün hastalarda elektrokardiyografi, kan basıncı ve satürasyon şeklinde standart monitörizasyon yapıldı. Sekiz ölçüm periyodunda alınan veriler istatiksel olarak analiz edildi: 1: ameliyat öncesi (bazal), 2: intravenöz medikasyon sonrası, 3: lokal anestezi sonrası, 4: ameliyat başlangıcından hemen sonra, 5, 6, 7: ameliyat süresince ve 8: ameliyat bitiminde. Bulgular: Kalp hızı ve kan basıncı seyrinde gruplar arasında anlamlı fark gözlenmedi. Sedasyon sonrası satürasyon değerleri gruplar arasında farklı bulundu (p0.01). Hemodinamik parametreler, midazolam ve remifentanil alan hasta grubunda stabil seyretti. Propofol ve remifentanil alan hastalarda ameliyatın ikinci yarısında görülen hipoventilasyon dışında yan etki gözlenmedi. Sonuç: Sinonazal cerrahide lokal anestezi ile birlikte uygulanan sedasyon tekniklerinden, midazolam-remifentanil kombinasyonu oldukça stabil hemodinami sağlamaktadır. Yan etkilerinin azlığı bakımından propofol-remifentanil kombinasyonu midazolam-remifentanile alternatif olabilir.Öğe The Effects of Combination of Verapamil and MK-801 on Rat Neuropathic Pain Model(2003) Özcan, Şaziye; Apan, Alpaslan; Gültekin, SüreyyaN-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.Öğe The effects of repeated sevoflurane anesthesia on renal tubular enzymes in rabbits(2003) Başar, Hülya; Büyükkoçak, Ünase; Kaymak, Çetin; Özcan, Şaziye; Tüzüner, FilizSevoflurane, one of new inhalation agents, is metabolized to organic and inorganic fluoride metabolites. Nephrotoxicity is due to free fluoride. In this study; we investigated the renal effects of repeated and different concentrations of sevoflurane anesthesia, experimentally. Sensitive urinary indicators n-asetil-d- glukozaminidaz (NAG), alkalen phosfatase (ALP), and gamma glutamil transferase (GGT) were assessed. This study was performed in 14, male New Zelland rabbits. Rabbits were divided into two groups (n=7). Group I (n=7) received sevoflurane 1% and Group II (n=7) 3% sevoflurane with O2+N2O (4 Lmin-1) 3 hours a dayfor 3 days Urine samples were collected via a special apparatus for 24 hours preoperative and after anesthesia. Urine samples were taken five days after the last administration of anesthesia and NAG, ALP and GGT levels in urine were determined. Blood samples taken from ear veins were obtained to determine BUN and Creatine. In Group II, urinary NAG levels increased significantly on the third day and a significant increase in GGT was observed on second and third days. There was no significant change in BUN, Cre and urinary ALP. NAG and GGT levels returned to normal on the 9th day. We concluded that, the effects of repeated sevoflurane administration on renal system are temporary.
