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Öğe Combination of adenosine with prilocaine and lignocaine for brachial plexus block does not prolong postoperative analgesia(Australian Soc Anaesthetists, 2003) Apan, A.; Basar, H.; Özcan, S.; Büyükkocak, Ü.Adenosine analogues have been used by subarachnoid injection for the treatment of inflammatory and neuropathic pain. There is no data on the use of adenosine in peripheral nerve blocks. The aim of the present study was to determine the analgesic efficacy of adenosine in combination with a local anaesthetic solution for brachial plexus (BP) block With local ethics committee approval, 50 consenting adult patients undergoing upper limb surgery were enrolled in this double-blind, prospective, randomized study. Patients with a history of bronchospastic disease were excluded. Patients were instructed not to take theophylline-containing drugs and beverages for at least one day before surgery or on the first postoperative day. A supraclavicular BP block was performed by injecting a mixture totalling 35 ml made up of prilocaine 1% 10 ml and lignocaine 2% 20 ml with adrenaline 1:200 000, and adenosine 10 mg in 5 ml saline (Group 1) or 5 ml saline (Group 2) as a placebo control group. Postoperative analgesia was assessed by time to first rescue analgesia, analgesic consumption in the first 24 hours, and VAS at rest at 4, 8, 12, 16, 20 and 24 hours. Side effects were also noted. Vital signs were stable in both groups throughout the operation. There were no significant differences between the groups in onset of motor and sensory block. Time to first pain sensation from block was not significantly longer in the adenosine group (379 +/- 336 min) compared with controls (304 +/- 249 min, mean +/- SD, P=0.14). Time to first analgesic requirements and analgesic consumption in the first 24 hours were also similar in both study groups. In the present study, the addition of adenosine to local anaesthetic in brachial plexus block did not significantly extend the duration of analgesia.Öğe A comparison of four intravenous sedation techniques and Bispectral Index monitoring in sinonasal surgery(Australian Soc Anaesthetists, 2003) Büyükkoçak, Ü.; Özcan, S.; Daphan, C.; Apan, A.; Koc, C.This study was performed to investigate the quality of different intravenous sedation techniques, and the correlation between the Bispectral Index (BIS) values and the Observer's Assessment of Alertness/Sedation (OAA/S) scores. Eighty patients undergoing sinonasal surgery were randomly assigned to one of four groups. Group MF received midazolam and fentanyl, group PF received propofol and fentanyl, group MR received midazolam and remifentanil, and group PR received propofol and remifentanil. Heart rate and mean arterial pressuure values were not different among the groups. SpO(2) decreased only after intravenous medication in groups MF and MR (P<0.017). Emesis was less common with propofol. A positive relationship existed between the BIS values and OAA/S scores during the operation in all groups and the strongest correlation was observed in group PR (r=0.565 and P<0.001). In conclusion, these four intravenous sedation techniques did not change mean arterial pressure, heart rate or SpO(2) clinically and produced a similar level of light sedation. The BIS was useful for monitoring of sedation during sinonasal surgery under local anaesthesia with intravenous sedation.Öğe Comparison of three analgesics for extracorporeal shock wave lithotripsy(Taylor & Francis As, 2002) Özcan, S.; Yilmaz, E.; Büyükkoçak, Ü.; Basar, H.; Apan, A.Objective: The aim of the study was to compare the clinical efficacy of three different analgesic drugs with respect to their level of sedation, analgesia and quick mobilisation without cardiopulmonary depression, for outpatient extracorporeal shock wave lithotripsy (ESWL) procedure. Material and Methods: Sixty outpatients undergoing elective ESWL using a third generation lithotriptor were studied. The patients were randomly divided into three groups of twenty patients. All patients received midazolam (2 mg) intravenously five minutes before the procedure. In group F, fentanyl was given (I mug kg-(1) IV) at the same time with midazolam. In group D, diclofenac sodium was given (I mg kg-(1), IM) intramuscularly 45 minutes before ESWL. In group T, tramadol was given (1.5 mg kg-(1)) 30 minutes before ESWL. Arterial pressure, heart rate, respiratory rate and oxygen saturation were recorded before the procedure, after sedation, at the first minute, and every ten minutes during the procedure. Pain intensity was identified with a Visual Analogue Scale. The level of sedation was evaluated by using the Observer's Assessment of Alertness/Sedation Scale. All patients were asked to assess their satisfaction with the seven point Verbal Rating Scale before discharge. Side-effects were also recorded during the procedure. Results: The incidence of nausea and vomiting was higher in fentanyl group compared with the other groups. In patients who received fentanyl, the decrease of oxygen saturation at the first and tenth minute of the procedure was statistically significant (p < 0.05). Conclusions: Diclofenac sodium and tramadol were found to be safe and effective analgesics with lower side-effects than fentanyl.Öğe Does hearing loss after spinal anesthesia differ between young and elderly patients?(Lippincott Williams & Wilkins, 2002) Gültekin, S.; Özcan, S.Fifty male patients scheduled for inguinal hernia repair with spinal anesthesia were included in this study. The patients were divided into two groups: 25 patients aged 30 yr or younger (Group Y) and 25 patients aged 60 yr or older (Group E). We performed subarachnoidal injection at the L3-4 interspace by using a 25-gauge Quincke needle with the patient in the sitting position, and 3 mL of 0.5% isobaric bupivacaine was administered. Patients were evaluated by pure tone audiometry (LdB [low frequencies], 125-500 Hz; SdB [speech frequencies], 500-2000 Hz; HdB [high frequencies], 2000-6000 Hz) on the day before and 2 days after spinal anesthesia. Low-frequency hearing loss observed in Group Y was significantly more common than in Group E (P < 0.01), There was no difference between the groups in speech and high frequencies. Mild hearing loss, defined as a hearing loss of 10-20 dB at two or more frequencies, was observed three times more frequently in Group Y than Group E (52% vs 16%; P = 0.014). We conclude that transient hearing loss was more common in young patients after spinal anesthesia, perhaps because the cerebrospinal fluid leakage after dural puncture is less in the elderly than in the young, a finding also associated with the infrequent incidence of postdural puncture headache in the elderly.Öğe Effect of bispectral index monitoring on sevoflurane consumption(Greenwich Medical Media Ltd, 2003) Başar, H.; Özcan, S.; Büyükkocak, Ü.; Akpinar, S.; Apan, A.Background and objective: The bispectral index, a parameter derived from the electroencephalograph, has been shown to correlate with the toss of consciousness and sedation. This study was designed to assess the effects of bispectral index monitoring on sevoflurane and its recovery profiles. Methods: Sixty ASA I and II patients undergoing open abdominal surgery were randomized into two groups: one monitored using the bispectral index (Group BIS) and the other without its use (controls). After a standardized induction, anaesthesia was maintained with sevoflurane in both groups. In Group BIS, sevoflurane was titrated to maintain the bispectral index in the range 40-60. In the control group, the administered sevoflurane concentration was adjusted according to the signs of anaesthesia. The end-tidal sevoflurane concentration, bispectral index and routine haemodynamic variables were noted every 5 min during surgery. The consumption of sevoflurane was computed. At the conclusion of surgery operations, the time to open eyes on verbal command', 'motor response to verbal command' and Aldrete's score were recorded by a blinded anaesthesiologist. Results: The difference in the consumption of sevoflurane was not significant between the groups. Bispectral index monitoring was associated with a reduction of 4.73% in sevoflurane usage and 2.19 mL h(-1) was saved. Conclusions: Bispectral index monitoring during anaesthesia provides only a small advantage related to the need to monitor the depth of anaesthesia.Öğe Music decreases anxiety and provides sedation in extracorporeal shock wave lithotripsy(Elsevier Science Inc, 2003) Yilmaz, E.; Özcan, S.; Basar, M.; Basar, H.; Batislam, E.; Ferhat, M.Objectives. To evaluate the efficacy of music on sedation in extracorporeal shock wave lithotripsy (ESWL) treatment to compare its anxiolytic effects with those of midazolam. Methods. Ninety-eight urolithiasis patients were randomly divided into two groups. Hemodynamic parameters, including mean arterial pressure, heart rate, respiration rate, and oxygen saturation, were recorded in all patients. In 50 patients (group 1), 2 mg of midazolam was administered intravenously 5 minutes before ESWL. In group 2 (n = 48), music chosen by the patients was listened to with a headset and continued during the treatment. The visual analog scale (0 to 100 mm), Observer's Assessment of Alertness/Sedation Scale, State and Trait Anxiety Inventory-Trait Anxiety test, and State and Trait Anxiety Inventory-State Anxiety test were administered for the evaluation of pain, sedation level, and patient anxiety. Results. For the hemodynamic parameters, a statistically significant decrease in mean arterial pressure was noted at the end of the ESWL procedure in group 2 and in oxygen saturation from the 10th minute to the end of the treatment in group I. Although the visual analog scale, Observer's Assessment of Alertness/Sedation Scale, and State and Trait Anxiety Inventory-State Anxiety test did not show statistically significant differences, the State and Trait Anxiety Inventory-Trait Anxiety score was found to be lower in the music group (group 2) than in the midazolam group (group 1). Conclusions. With the anxiolytic effects of music, ESWL can be performed more effectively with the patient in a comfortable state. Listening to music by patients during the ESWL session is a feasible and convenient alternative to sedatives and anxiolytics.Öğe Perioperative intravenous adenosine infusion to extend postoperative analgesia in brachial plexus block(Lippincott Williams & Wilkins, 2003) Apan, A.; Özcan, S.; Büyükkocak, Ü.; Anbarci, O.; Basar, H.Background and objective: Adenosine infusions have been shown to reduce requirements of anaesthetics, to decrease the need for postoperative analgesics and to attenuate hyperaesthesia related to neuropathic pain. We decided to investigate the effects, beneficial or otherwise, of an adenosine infusion administered during surgery. A brachial plexus block was used to produce anaesthesia for the surgery. Methods: Sixty adults undergoing upper extremity surgery were included in the study. Brachial plexus block was performed via an axillary approach with lidocaine 1.25 % and epinephrine 1/200 000 (40 mL). Patients were randomly assigned to two groups. During surgery, saline (control) or adenosine 80 mug kg min was infused intravenously in a double-blind fashion for 1 h. Visual analogue scores every 4 h, analgesic consumption, time to first spontaneous pain sensation, time to first rescue analgesic and adverse effects were noted during the first 24 h. Results: Vital signs were stable in both groups throughout surgery. During the adenosine infusion, one patient fainted while another complained of palpitations and tightness of the chest; both patients were excluded from further analyses. The time to first sensation of pain was significantly longer in the adenosine group compared to the control group (438 +/- 387 vs. 290 +/- 227 min, P = 0.02). The time to first rescue analgesic, the visual analogue scale scores and analgesic consumption in the postoperative period were similar. Conclusions: In patients undergoing surgery with an axillary plexus block, a perioperative adenosine infusion prolongs the duration of postoperative analgesia to some extent. However, the time to first rescue analgesic, total analgesic requirements and pain scores were unchanged; the risk of potentially serious adverse effects is high. This therapy cannot be recommended.
