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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 The comparison of the effectiveness of bupivacaine 0.375% with ropivacaine 0.75% on combined sciatic and femoral block(Lippincott Williams & Wilkins, 2004) Sary, F.; Ozcan, S.; Apan, A.…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 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 The effect of changing pressures on dural puncture and leak with various spinal needles on an in vitro model(Churchill Livingstone, 2002) Apan, A.; Uz, A.; Ugur, H.C.; Tekdemir, I.Postdural puncture headache is one of the most serious complications of spinal anesthesia. In this study, spinal needles of various types and shapes were used to investigate the amount of fluid leakage in dural puncture under various pressures. Dura samples received from 10 cadavers were fixed in an in vitro model. The dural punctures were inflicted with 22 G, 25 G, and 27 G Quincke; 25 G Withacre; 25 G, 27 G Pencan, and 26 G Atraucan spinal needles. The fluid, which leaked during the process, was collected under the pressures of 0, 25, 50, 100, and 150cm H2O in a one-hour period for each level. The holes in the dura were studied under the light microscope. While 22 G and 25 G Quincke needles were used, the fluid leakage directly correlated with the amount of liquid, the diameter of the needle, and the pressure used. The puncture of 25 G Withacre and 25 G Pencan presented a leakage which did not significantly vary with the liquid pressure and was of lesser amount. In 26 G Atraucan, 27 G. Pencan, and 27 G Quincke inflicted punctures, little liquidwas collected and it did not vary with differing pressures. Thus, no significant correlation was established between the needle diameter and the puncture. It was concluded that the sharp-ended needles could not endure changes in the pressure. However, those needles with a very thin diameter and a pencil tip were considered as safe tools for anesthetic practice. (C) 2002 Elsevier Science Ltd. All rights reserved.Öğe Effects of electrohydraulic extracorporeal shock wave lithotripsy on submandibular gland in the rat: electron microscopic evaluation(Elsevier Sci Ireland Ltd, 2002) Bayar, N.; Kaymaz, F.F.; Apan, A.; Yilmaz, E.; Cakar, A.N.Objectives: Extracorporeal shockwave lithotripsy (ESWL) has been applied in sialolithiasis as a new treatment modality. The aim of this experimental study is to investigate the local effects of electrohydraulic ESWL applied to the right submandibular gland of the rats. Methods: This prospective study was conveyed in four groups groups I, II, III and IV: each group consisting of 20, 20, 18 and 9 rats, respectively, with a randomized distribution, Groups I, II, III and IV received 250, 500, 1000 and 2000 shock waves at 14-16 kV (average 15.1 kV), respectively, to the right submandibular glands on the 0th day. In groups I, II, III, right submandibular glands of the rats were removed on the 0th 1st, 7th and 15th days, in group IV, this procedure could be managed only on the 0th and 7th days. Light and electron microscopic evaluation were assessed, Using the light microscopic changes, severity of damage score of the glands (SDS) was found. Statistical analysis was done using SDSs. Results: Light and electron microscopic observations have shown that the damage produced by the shock waves were confined to focal areas in the acinar cells (AC), granulated convoluted tubule (GCT) cells and blood vessels at all doses applied. Vacuolization in the cytoplasms of the AC and GCT cells, disintegration of membranes, alteration in the cytoplasmic organization, swelling of the mitochondria and loss of the features were observed on electron microscopy. Increase in the secretion rate; stasis and dilatation in the blood vessels: blebbing and loss of features in the cytoplasm of the endothelial cells were observed, According to the result of the statistical analysis using SDSs, at 250 shock wave dose, a statistically significant difference between the SDSs of the days (0th, 1st, 7th and 15th) was found (P < 0.05), The SDS on the 0th day was found to have the lowest value among the other days. And also a statistically significant difference was found on the 0th day between the SDSs at doses of 250, 500, 1000 and 2000 shock waves (P < 0.05). The SDS at 250 and 500 shock waves was found to have the lower value than the SDS at the 2000 shock wave. It was observed that produced damage was less prominent by small doses (250, 500 doses) initially (0th day). Electrohydraulic ESWL caused a "patchy type" generalized pathology on submandibular glands of the rats and damaged focal areas were widespread all through the gland from the 1st day on. Conclusion: Formation of the damage was concluded to be related to the direct effect of the shock waves rather than the dose used. Electrohydraulic lithotripters are not suitable for sialolithiasis because of the focus problems, local tissue damage and the risk of the damage to the adjacent structures. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe Effects of intracisternal tramadol on cerebral and spinal neuronal cells in rat(Edizioni Minerva Medica, 2014) Kose, E. A.; Bakar, B.; Ayva, S. K.; Kilinc, K.; Apan, A.Background. The aim was to investigate whether tramadol had toxic effect on cerebral neurons and/or spinal cord neurons when it was administered into the cerebrospinal fluid. Due to lipid peroxidation (LPO) and myeloperoxidation (MPO) levels are not specific predictors of neuronal damage, these biochemical markers of tissue damage were evaluated together with the histopathological findings of apoptosis. Methods. Forty eight Wistar rats were anesthetized and the right femoral artery was cannulated. Mean arterial pressures, and heart rates, arterial carbon dioxide tension, arterial oxygen tension, blood pH were recorded. When the free cerebrospinal fluid flow was seen; 0.04 mL normal saline (Group Sham) or diluted tramadol in 0.04 mL volume (Group T1, T2, T0.5 and T0.1) was administered within 30 seconds from the posterior craniocervical junction of rats. For the Control Group, the free cerebrospinal fluid flow was seen but nothing was injected in it. After 7 days, following the sacrification of the rats, brain tissue, cervical and lumber segments of spinal cord were collected for the histopathological and biochemical examination. Results: There was not a statistically significant difference among all groups regarding the brain LPO levels (P=0.485). The LPO levels of the cervical segment of spinal cord and the lumbar segment of spinal cord were also similar (P=0.146, P=0.939, respectively). The mean MPO levels of the cervical and the lumbar segments of spinal cord were similar among all groups (P=0.693, P=0.377, respectively). There were not any statistically significant difference regarding the total number of red neurons of the brain tissue and the cervical and lumbar segments of spinal cord among all groups (P=0.264, P=0.202, P=0.780, respectively). Conclusion. Tramadol had no neurotoxic effect on brain and on spinal cord tissue when administered by the intracisternal route in cerebrospinal fluid in rats.Öğe Efficacy of topotecan treatment on an experimental model of transient evoked otoacoustic emissions(Elsevier Ireland Ltd, 2001) Bayar, N.; Boke, B.; Apan, A.; Koc, M.C.Objective: The aim of this study was to investigate the effects of topotecan (Hycamtin(R)), a topoisomerase I inhibiting anticancer agent, on Transient Evoked Otoacoustic Emissions (TEOAEs) of the rabbits. We planned to investigate whether this test might provide a method for monitoring early ototoxic influence of drug administration to the cochlea. Methods: The study was conveyed in two groups each consisting of five rabbits with a total of ten ears. Rabbits in group I received i.v. topotecan (0.5 mg/kg once daily) for 3 days. Rabbits in group II received i.v. topotecan (0.25 mg/kg once daily) for 3 days. Cochlear function was serially monitored using transient evoked otoacoustic emissions before administration (BA) and on the 4th and 15th days after administration of topotecan. TEOAEs were analysed in terms of mean stimulus, stability and emission amplitude at 1.0-4.0 kHz. Results: For group I and II, intergroup and intragroup, differences were not statistically significant in the mean stimulus, stability and emission amplitudes at 1.0-4.0 kHz. Conclusions: We evaluated the potential role of TEOAEs in early identification of cochlear dysfunction induced by, topotecan. It was concluded that topotecan did not have ototoxic effects on the cochlea in the early period of administration. TEOAEs may be useful: to monitor the cochlear function and to detect the late stage of ototoxicity especially in the presence of potentially toxic factors for the prevention of permanent damage. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.Öğe Four analgesic techniques for shockwave lithotripsy: Eutectic mixture local anesthetic is a good alternative(Mary Ann Liebert, Inc, 2003) Basar, H.; Yilmaz, E.; Ozcan, S.; Büyükkoçak, Ü.; Sari, F.; Apan, A.; Batislam, E.Background and Purpose: Various sedative and analgesic medication has been used for shockwave lithotripsy (SWL). The aim of this study was to evaluate the efficacy of different anesthesia modalities in these patients. Patients and Methods: One hundred patients were randomly divided into four groups. The first (Group F) received fentanyl 1 mug/kg intravenously (IV), the second (Group D) received diclofenac sodium 1 mg/kg-intramuscularly (IM), the third (Group T) received tramadol 1.5 mg/kg IM, and the fourth (Group E) was given 15 g of eutectic mixture local anesthetic (EMLA) cream containing lidocaine and prilocaine. After routine preoperative evaluation, all patients received midazolam 2 mg IV 5 minutes before lithotripsy for sedative premedication. In all groups, a supplemental 25-mug bolus of fentanyl was administered IV when patients complained of pain, moved, or grimaced in response to the shockwaves. Pain intensity was evaluated on a 0- to 100-mm visual analog scale (VAS). The level of sedation was determined using the Observer's Assessment of Alertness/Sedation (OAS/S). Side effects such as bradypnea, oxygen desaturation, bradycardia, pruritus, and nausea and vomiting were recorded. Results: There were no statistically significant differences among the four groups with regard to VAS, OAS/S scores, or side effects. In Group F, the mean arterial pressure was decreased significantly at 10 and 20 minutes. The patients in this group also manifested a decrease of oxygen saturation at the first, tenth, and twentieth minutes and the end of SWL. Conclusion: Application of EMLA cream was as safe and effective as fentanyl, diclofenac, and tramadol,. and reduction of the fentanyl dose during SWL was possible.Öğe Ischaemia-reperfusion injury of rat ovary and the effects of vitamin C, mannitol and verapamil(Oxford Univ Press, 2002) Sagsöz, N.; Kısa, Ü.; Apan, A.BACKGROUND: In this prospective controlled study, the aim was to examine the effects of vitamin C, mannitol and verapamil on adnexial ischaemia-reperfusion injury in the rat ovary. METHODS: Thirty-six female Wistar rats were used. In the controls (group 1), only laparotomy was performed. In group 2, ovarian ischaemia was produced and the bilateral ovaries were surgically removed 4 h later. In group 3, an ischaemic period of 4 h was followed by reperfusion for 1 h; the bilateral ovaries were then removed. In groups 4, 5 and 6, after 4 h of ischaemia, either vitamin C, mannitol or verapamil respectively was infused before reperfusion; after 1 h of reperfusion the ovaries were removed. Thiobarbituric acid reactive substance (TBARS) levels were measured in all ovary tissues. RESULTS: TBARS levels of the reperfusion group were significantly higher than those of groups treated with vitamin C or mannitol (P = 0.013 and P = 0.045 respectively), but not of the verapamil group. CONCLUSIONS: Vitamin C and mannitol were found to be effective in reducing ischaemia-reperfusion injury of the ovary during its early stages, but verapamil was ineffective.Öğe Perception of bronchoconstriction in elderly asthmatics(Taylor & Francis Ltd, 2001) Ekici, M.; Apan, A.; Ekici, A.; Erdemoglu, A.K.The impaired perception of bronchoconstriction in asthmatic patients may increase the risk of severe exacerbation. To characterize the perception of bronchoconstriction in elderly asthma patients, we compared the perception in older patients with that of younger patients. To determine the influence of perception of long-standing diseases, we further evaluated the perception in early-onset elderly asthma patients and in late-onset elderly, asthma patients. The study group consisted of 80 stable asthmatic patients. The patients were grouped according to their age (group 1, < 60 years, n = 37; group 2 greater than or equal to 60 years, n = 43). Each group was separated into two subgroups according to the duration of symptoms (late-onset asthma IA and 2A, <5 years, early-onset asthma IB and 2B, greater than or equal to 5 years). A histamine inhalation test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in forced expiratory volume in I see (FEV1) reduction by 20% was determined as perception score 20 (PS20). The mean perception scores of the elderly asthmatic patients were significantly lower than those of the younger asthmatic patients (group 1, PS20 = 2.35 +/- 0.17; group 2, PS20 = 1.37 +/- 0.12; p < 0.0001). The differences of mean perception score (PS20) between early- and late-onset subgroups were insignificant (1A, 2.63 +/- 0.30 and IB, 2.07 +/- 0.16; p = 0.101: 2A, 1.36 +/- 0.19 and 2B, 1.59 +/- 0.120; p = 0.91). The mean perception scores of male asthmatic patients were significantly lower than those of female patients (p = 0.03). There was a correlation between PS20 and %FEV1 in the younger group (r = 0.392, p = 0.02), but not in the elderly, group (r = 139, p = 0.375). The correlation between PS20 and PD20 in both younger and elderly group was insignificant (p > 0.05). Elderly, asthmatics perceive less intense respiratory, distress for a decrease of 20% in FEV1 than do younger asthmatics. This underperception of bronchoconstriction may result in a delay in medical care during an acute asthmatic episode. Thus, we strongly recommend that elderly, asthmatic patients should be followed up more frequently and closely.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.Öğe Postoperative magnesium sulphate infusion reduces analgesic requirements in brachial plexus block(Lippincott Williams & Wilkins, 2004) Anbarci, O.; Apan, A.; Ozcan, S.…Öğe Surface landmarks and anatomic relationships of sciatic nerve for anaesthetic blockade: cadaveric study(Lippincott Williams & Wilkins, 2004) Apan, A.; Uz, A.; Tekdemir, I.; Elhan, A.…
