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Öğe Bispectral index-guided intraoperative sedation with dexmedetomidine and midazolam infusion in outpatient cataract surgery(Edizioni Minerva Medica, 2009) Apan, Alparslan; Doganci, N.; Ergan, A.; Büyükkoçak, ÜnaseBackground. This study aimed to evaluate the role of alpha-(2) agonist in fusion, with dexmedetomidine or midazolam, on hemodynamic and respiratory parameters while titrating the sedation level with the bispectral index (BIS) during cataract surgery. Methods. Ninety consenting ASA class I-III patients who were electively undergoing cataract surgery were en rolled in the double blind study. A random infusion of 0.25 mu gxkg(-1) xhr(-1) Dexmedetomidine (Group D), 25 mu g x kg-1.hr(-1) midazolam (Group M), or saline for controls (Group Q was administered after mounting a BIS monitor and routine anesthetic care. The target BIS level was >85. An additional bolus dose in 1 mL increments of the study drug or cessation of the infusion was adjusted according to the BIS level. Changes in respiratory and vital parameters were noted and, in case of mild pain, 25 mu g fentanyl was administered as a bolus. Pain and sedation were evaluated in the early postoperative period using Visual analogue and four rating sedation scales. Results. In Group D, heart rate decreased in the later periods Of surgery (35-50 min) and in the early postoperative Period (5(th) and 15(th) min). Dose adjustments were required in six and tell patients in Groups D and M, respectively Pain scores were lower with dexmedetomidine infusion. Conclusion. Dexmedetomidine infusion mildly decreased heart rate in the later periods of surgery with better pain scores in the postoperative period. Dexmedetomidine Should be an alternative for intraoperative sedation ill Outpatient cataract Surgery.Öğe Caudal epidural block for elderly patients who have limited cardiac reserve(Tubitak Scientific & Technical Research Council Turkey, 2012) Kose, Emine Arzu; Ozturk, Aliye; Ates, Gulnaz; Apan, AlparslanThe choice of anesthetic technique based on its advantages and disadvantages in elderly patients will inevitably be influenced by the patient's comorbidities, such as cardiovascular disease, diabetes mellitus, stroke, renal insufficiency, and pulmonary disease. The patient's underlying cardiac conditions, although apparently stable at present, may become manifest during perioperative stresses. Caudal epidural block should be taken into consideration as a safe and effective anesthetic technique for the elderly patients who have limited cardiac reserve and comorbidities. Six patients with low ejection fraction and poor functional status due to ischemic cardiac disease scheduled for surgery under caudal epidural block are presented.Öğe CNS Toxicity after Combined Sciatic and Femoral Nerve Block with Lidocaine(2004) Özcan, Ş.; Apan, Alparslan; Büyükkoçak, Ü.; Başar, H.; Erdemoğlu, Ali KemalCombined 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.Öğe Comparison of hemodynamic effects with thoracic electrical bioimpedance monitoring in desfiumne anaesthesia applied with low and high flow(2007) Kaymak, Çetin; Başar, Hülya; Tekin, Özlem; Sert, Özgür; Apan, AlparslanBackground and Goal of Study: After the removal of exhaled CO2, rebrcathing of 50% or more of exhaled gases is possible during low flow anaesthesia. The purpose of this study is to compare the thoracic electrical bioimpedancc (TEB) method for hcmodynamic monitoring under low flow and high flow desfluranc anaesthesia. Material and Methods: After Institutional Ethics Committee approval, 40 ASA I-II patients scheduled for elective surgery were included into the study. For all patients, anaesthesia was induced with 1.5 ?g kg-1 fentanyl and 5-7 mg kg-1 thiopcnthal. The trachea was intubated after 0,1 mg kg-1 vecuronium, Patients were randomly divided into two groups to receive low flow (1 L min-1 50% N2O+O2) in group I or high flow (4 L min-1 50% N2O+O2) in group II with 4-6%. Ejection fractions (EF), end-diastolic indexes (EDI), cardiac indexes (CI), stroke indexes (SI) were monitored and recorded with noninvasivc TEB for basal, induction, intubations and 15 min. intervals. The level of anaesthesia was adjusted by the concentration of dnsflurane to achieve a target BIS in the range of 40-60. Postoperative Aldrete Recovery Score (ARS) was recorded. Student-t test and repeated measures of variance were used to statistical analysis. p<0.05 was accepted statistiealy significant. Results: The concentrations of end-tidal desfluranc in group II were significantly higher than group I at the 45 th and 60th minutes (p<0,05). The EDI at 45 th and 60th minutes in group I were significantly higher than group II (p<0.05). The values of CI, SVI and EF were similar in group I and II. The ARS at 5th and 10th minutes were significantly higher in group I. Conclusion: We concluded that low flow or high flow anaesthesia technique by desfluranc has similar hemodynamic effects by using TEB method.Öğe Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain(2007) Kemal, Sibel Özçakır; Şahin Selman; Apan, AlparslanComparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain. The aim of the present study was to compare of the postoperative analgesic effects of tramadol, combinations of tramadol-metamizol and tramadol-lornoxicam administered by intravenous Patient Control Analgesia (PCA) in lower abdominal surgery. Sixty adult, female patients who undergoing lower abdominal surgery, were included in this study. Patients were randomized to three groups. The solutions were prepared containing 500 mg tramadol in 50 ml saline (10 mg/ml tramadol) for Group I, 250 mg tramadol+3000 mg metamizol in 50 ml saline (5 mg/ml tramadol+60 mg/ml metamizol) for Group II and 250 mg tramadol+20 mg lornoxicam in 50 ml saline (5mg/ml tramadol + 0.4mg/ml lornoxicam) for Group III. Loading dose 10 ml was administrated within 30 min 30 to 40 min before the end of the surgery. PCA was started at the first complaint of pain. Pain was evaluated by VAS in every 15 minute intervals at the first hour and later at 2nd, 4th, 8th, 12th, 18th and 24th hours postoperatively. Vital parameters, side-effects, sedation scores and total analgesic consumptions were also recorded concurrently. Total tramadol and anti-emetic consumption, the incidence of postoperative nausea and vomiting (PONV) were significantly higher in group I than the other groups (p<0.05). In conclusion; Tramadol-metamizol and tramadol-lornoxicam combinations administered by intravenous PCA provide efficient postoperative analgesia with less side effects.Öğe Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain(Kare Publ, 2007) Kemal, Sibel Ozcakir; Sahin, Saziye; Apan, AlparslanComparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain. The aim of the present study was to compare of the postoperative analgesic effects of tramadol, combinations of tramadol-metamizol and tramadol-lornoxicam administered by intravenous Patient Control Analgesia (PCA) in lower abdominal surgery. Sixty adult, female patients who undergoing lower abdominal surgery, were included in this study. Patients were randomized to three groups. The solutions were prepared containing 500 mg tramadol in 50 ml saline (10 mg/ml tramadol) for Group I, 250 mg tramadol+3000 mg metamizol in 50 ml saline (5 mg/ml tramadol+60 mg/ml metamizol) for Group II and 250 mg tramadol+20 mg lornoxicam in 50 ml saline (5mg/ml tramadol + 0.4mg/ml lornoxicam) for Group III. Loading dose 10 ml was administrated within 30 min 30 to 40 min before the end of the surgery. PCA was started at the first complaint of pain. Pain was evaluated by VAS in every 15 minute intervals at the first hour and later at 2nd, 4th, 8th, 12th, 18th and 24th hours postoperatively. Vital parameters, side-effects, sedation scores and total analgesic consumptions were also recorded concurrently. Total tramadol and anti-emetic consumption, the incidence of postoperative nausea and vomiting (PONV) were significantly higher in group I than the other groups (p<0.05). In conclusion; Tramadolmetamizol and tramadol-lornoxicam combinations administered by intravenous PCA provide efficient postoperative analgesia with less side effects.Öğe Determining the aortic and renal hemodynamic effects of propofol on rabbits using Doppler ultrasonography(2004) Apan, Alparslan; Karadeniz Bilgili, M.Yasemin; Çağlayan, FatmaPURPOSE: The hemodynamic effects of propofol-fentanyl anesthesia were known to reduce arterial pressure and heart rate. We aimed to determine the effects of propofol-fentanyl anesthesia on renal artery blood flow and aorta by using Doppler ultrasonography on an animal model. MATERIALS AND METHODS: The study was conducted on 8 male New Zaeland White strain rabbits. The initial aortic and renal hemodynamic measurements were determined on animals using ketamin anesthesia. Later the right femoral arteries were cannulated for determining arterial blood pressure and pulse oximetry was followed from the ear. Propofol 5-7 mg/kg with fentanyl 1-2 microg/kg was injected via the ear vein. Doppler parameters (RI, RI, Vmax, Vmin) of the renal artery and aorta were determined after the anesthesia. RESULTS: According to the basal measurements, arterial blood pressure and breath rates declined significantly (27% and 53% respectively, p<0.05); however there were no statistical alteration of aortic and renal artery Doppler parameters. CONCLUSION: Anesthesia induced by propofol-fentanyl did not induce a statistically significant difference in Doppler parameters obtained from the renal artery and aorta. It is clinically important to know that determining the changes in RI and PI during the postoperative period is not related to the propofol-fentanyl anesthesia.Öğe The Effects of Combination of Verapamil and MK-801 on Rat Neuropathic Pain Model(2003) Özcan, Ş.; Apan, Alparslan; Gültekin, SenaN-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 cyclohexyladenosine on cold water swim stress (CWSS) induced analgesia(2000) Apan, AlparslanCold water swimming induces analgesia on rats and mice. This analgesia is abolished by non-selective ? receptor antagonist naloxone and appears by delta-2 specific ? receptor agonist. The relation between CWSS and adenosine agonists are not investigated. The purpose of this study is to investigate the effect of adenosine A1 receptor agonist cyclohexyladenosine (CHA) on CWSS induced analgesia. 75 Swiss Webster male mice, weighing 25-35 g was included to the investigation. Animals were divided into five equal group in a random order. Research protocol was determined as: 1st injection - 5 min - 3 min CWSS - 2 min - 2nd injection; 10, 20, 30 min after hot plate test (HPT). Vehicle saline (S) solution was administered to the 1st group of mice on both injections. 8 phenylteophylline (8 PT) 50 mg/kg and S was given to the 2nd group of animal. S and CHA 2 mg/kg was injected to the 3rd group of mice. 8 PT 50 mg/kg and CHA 2 mg/kg was administered to the 4th group of animals respectively. On the 5th group, 8 PT 50 mg/kg was given for first injection and CHA 1 ?g/kg (5 ?L) was injected via intracerebroventricular route. All injections were performed with 30 G tipped insulin injector at same volume (0.1 mL) by intraperitoneal or subcutaneous route. Water temperature was determined as 10°C. Mice were placed on 56°C test surface which separated by visible glass chamber. Characteristic fore limb licking, hind limb shaking or withdrawal were taken as positive signs. The period for reaction was determined as latency. CWSS was augmented the systemic effects of CHA. Analgesia was not abolished by non-selective adenosine antagonist 8 PT. CHA alone was not further effect on CWSS induced analgesia. There were no obvious difference between CHA administered at either central and peripheral route on 8 PT pre-treated animals with vehicle group. These results declares that there is no effect of adenosine agonists on CWSS induced analgesia. In conclusion, the analgesia which appeared by CWSS produced ceiling effect. CHA administration did not produce additional analgesia but augmented other systemic effects of adenosine agonists.Öğe The effects of diclofenac sodium on cold water swim induced analgesia(1998) Apan, Alparslan; Öztürkmen A.It was clearly demonstrated that cold water swimming induces analgesia in mice and rats; produced by opioid and non-opioid mechanisms. Aim of this study is to determine the effect of diclofenac sodium (DS) on this phenomenon. 60 Swiss Webster strain albino male mice (average weight 25-35 gr) was investigated ethic committee approval. Animals were separated into four equal group in a randomised fashion. Normal saline (Control: C) was given to the 1st group, naloxone (NL) 100 mg/kg was given to the 2nd group, diclofenac sodium (DS) 2 mg / kg was given to the 3rd group and diclofenac sodium 2 mg/kg with naloxone 100 ?gr / kg (DS+NL) to the 4th group of animals 7 minutes before cold water swim stress (CWSS) test at same volume (0.1 ml) by intraperitoneal (IP) route. CWSS was performed at 10°C water for 3 minutes. Animals were taken to the separate chamber and dried gently. Hot plate test (HPT) at 56°C was performed 10 minutes later. Animals were exposed to HPT maximal 20 seconds to prevent tissue injury. Characteristic fore limb licking, hind limb shaking or withdrawal were taken as positive result. Data were expressed as mean ± standard deviation of mean (Mean ± SD). Analyses of variance (ANOVA), student's t test and Mann-Whitney u test were used for statistical analyses. P<0.05 was taken as significant. There were no differences between groups on basal temperature. Also, no differences were found between HPT results on C and DS; NL and DS+NL treated animals. In comparison significant differences were found between C and DS groups with NL and DS+NL given animals (p<0.05). Regarding to these results there were no additional effects of DS on CWSS analgesia at given doses. This analgesia decreased by NL and doesn't change by DS. Study design will be constructed and directed to the tonic pain models.Öğe The effects of N-methyl-D-aspartate antagonist MK-801 and adenosine receptor agonists on mononeuropathic rats(2001) Apan, AlparslanThe present study was to determine whether administration of adenosine A1 receptor agonist cyclohexyladenosine (CHA) and adenosine A1/A2 receptor agonist 5?N-ethylcarboxamidoadenosine (NECA) and N-methyl-D-aspartate antagonist MK-801 on thermal nociception in rat chronic constriction injury model. 48 Sprague Dawley male rats weighting 185-225 g were included to the study. The right common sciatic nerves were ligated loosely with four 4/0 chromic gut under barbiturate anesthesia. Drugs were administered and nociceptive test performed for four days after 7 days' recovery. NECA, CHA and MK-801 were administered two times at doses of 0.1 mg/kg, 1 mg/kg, and 1 mg/kg respectively. The doses were inclined to the half while both of two drug were given. Noci-ceptive threshold was determined by hot plate test at 46°C during treatment period. Time to jumping or licking of the limb on the operated site was determined. The thermal test results of MK-801 given animals were demonstrated antinociception initially, but declined to the baseline through the treatment period. Antiallodynic effects reduced on CHA group when combined with MK-801. The nociceptive treshold of NECA treated animals were as the same with NECA+MK-801. Antiallodynic effects of NECA were partly due to its motor blocking properties. The results we obtained appear to be disappointing while both of two class of drugs given systemically acting as glutamate antagonist. The future studies may be directed to the other routes which may act synergistically.Öğe Effects of ropivacaine on transient-evoked otoacoustic emissions: a rabbit model(Springer, 2006) Arıkan, Osman Kürşat; Muluk, Nuray Bayar; Budak, Bilgehan; Apan, Alparslan; Budak, Gürer; Koç, CanThe aim of this study was to investigate the effect of ropivacaine, a newer amide local anesthetic, on the ears of rabbits by using transient-evoked otoacoustic emissions (TEOAEs). Thirty rabbits were studied in a random block design of six groups of five animals each. There received intra-tympanically instilled single doses of 0.5 mg/kg, 1.0 mg/kg of ropivacaine, 0.5 ml of isotonic saline (control for intratympanic application), or intravenously administered single doses of 1.0 mg/kg, 2.0 mg/kg of ropivacaine and 1.0 ml of isotonic saline (control for intravenous application). Cochlear function was serially monitored using TEOAEs before administration and on the 1st and 15th days after administrations of ropivacaine or isotonic saline. The responses of TEOAEs were analyzed in terms of mean stimulus, stability, wave reproducibility and emission amplitudes at 1.0-4.0 kHz. We found no significant changes in the TEOAE responses of the baseline measurements in each group before administration and the responses at each interval in the same group after administration throughout the experiment (P > 0.05). Also, no significant difference was found between the group receiving ropivacaine administered intravenously or intratympanicly and the control group at each interval (P > 0.05). The data from the present study showed that ropivacaine, whether administered intravenously or intratympanically and even at a low or high dose, has no effects on the responses of TEOAEs in the early period. These findings encourage the use of ropivacaine as a safe agent without ototoxic effects in peripheral nerve blocks, epidural and intravenous regional anesthesia or even tinnitus therapy in the future.Öğe The Effects of Tramadol and Levobupivacaine Infiltration on Postoperative Analgesia in Functional Endoscopic Sinus Surgery and Septorhinoplasty(Galenos Yayincilik, 2012) Koputan, Muhammet Hilmi; Apan, Alparslan; Oz, Goksen; Kose, Emine ArzuObjective: The aim of this prospective, randomized, double-blind study was to investigate the postoperative analgesic effects of levobupivacaine or tramadol infiltration administered prior to surgery in septorhinoplasty (SRP) or endoscopic sinus surgery (ESS). Material and Methods: Sixty ASA class I-III adult patients electively undergoing SRP or ESC were included the study. Induction of anesthesia was performed with propofol 2-2.5 mg/kg, rocuronium bromide 0.6 mg/kg and fentanyl 1 mu g/kg i.v. Sevoflurane 2% with an N2O/O-2 mixture (FiO(2): 35%) was used for maintenance. Tramadol 0.5 mg/kg (Group T: n=20), levobupivacaine 0.25% (Group L: n=20) and lidocaine 1% (Group C: n=20) in a 1/200,000 adrenaline solution was infiltrated into the surgical area 10 min before the operation (5 mL for ESS and 10 mL for SRP). All patients received fentanyl (bolus dose: 15 mu g and lockout interval: 10 min) with a patient-controlled analgesia device during the postoperative period. Pain was assessed using an 11-point visual analogue scale WAS) every 4 h for the first 24 h. Analgesic requirements, opioid consumption and side effects in the postoperative period were recorded. Results: There was a statistically significant decrease in postoperative fentanyl demand and consumption in patients receiving tramadol. Fentanyl doses in the 24 h period were 345.2 +/- 168.8 mu g, 221.1 +/- 120.6 mu g and 184.1 +/- 130.3 mu g (p=0.002) for the Groups C, L and T, respectively. There were statistically significant differences in fentanyl requirements between the tramadol and control groups at the 16, 20 and 24 h time points (p=0.012, p=0.004 and p=0.002, respectively). The side effect profiles were similar. Conclusions: Our study indicates that the preemptive tramadol infiltration technique is an efficient, practical and safe alternative to levobupivacaine in ESS or SRP operations.Öğe Efficacy of topotecan treatment on antioxidant enzymes and TBA-RS levels in submandibular glands of rabbits: An experimental study(Sage Publications Ltd, 2005) Muluk, Nuray Bayar; Kısa, Üçler; Kaçmaz, Murat; Apan, Alparslan; Koç, CanOBJECTIVE: The aim of this study was to investigate the effects of topotecan (Hycamtin), a topoisomerase I inhibiting anticancer agent, on antioxidant enzymes (SOD, CAT, and GSH-Px) and TBA-RS values of the submandibular glands of the rabbits. STUDY DESIGN AND SETTING: The study was conveyed in two groups (Group I, II) and control with a total of 24 rabbits. Eight rabbits in group I received intravenous (i.v.) topotecan (0.25 mg/kg once daily) for 3 days. Eight rabbits in group II received i.v. topotecan (0.5 mg/kg once daily) for 3 days. On the 15th day after administration of topotecan, submandibular glands were removed and levels of the SOD, CAT, and GSH-Px and the TBA-RS in the submandibular glands of the rabbits were examined. RESULTS: SOD, CAT, and GSH-Px values were significantly higher in high-dose topotecan group compared to control group (P < 0.05). SOD and TBA-RS values were significantly higher in high-dose topotecan group compared to low-dose topotecan group (P < 0.05). CONCLUSION: It was concluded that, to prevent the hazardous effects of oxygen free radicals due to topotecan, antioxidant enzymes SOD, CAT, and GSH-Px were increased. The higher levels of the TBA-RS values in group II showed that permanent damage was present because of high-dose topotecan administration in the submandibular glands of the rabbits.Öğe Epidural tramadol infiltration decreases postoperative analgesic consumption after lumbar microdiscectomy(2012) Şahin, Yasemin; Apan, Alparslan; Öz, Gökşen; Evliyaoğlu, Çetin AyhanAmaç: Çalışmanın amacı epidural tramadol infi ltrasyonunun postoperatif analjezik etkilerini araştırmak. Tramadol lokal anestezik ve antienfl amatuvar özellikleri de bilinen zayıf opioiddir. Yöntem ve gereç: Genel anestezi altında lomber mikrodiskektomi operasyonu geçiren ASA I veya II sınıfı 60 hasta çalışmaya alındı. Anestezi indüksiyonu 2-2.5 mg kg–1 propofol, 0.5 mg kg–1 roküronyum bromid, ve 1 ?g kg–1fentanil ile sağlandı. Anestezi idamesinde % 2-2,5 sevofl uran ve N2O/O2 (FiO2 = % 35) karışımı kullanıldı. Hastalar rastgele iki gruba ayrıldı. Çalışma grubunda operasyonun sonunda cerrahi saha kapanmadan önce epidural bölgeye 5 mL salin içinde 1 mg kg–1 tramadol verilirken, kontrol grubunda hastalara eşit volümde salin uygulandı. Ağrı vizüel analog skala (VAS) ile (0 ila 10 cm) her 4 saatte bir postoperatif ilk 24 saat boyunca değerlendirildi. Hasta kontrollü analjezi (HKA) cihazı 15 ?g fentanil bolus istek 10 dakika kilitli kalacak şekilde ayarlandı. Bulgular: Her iki grup arasında VAS değerleri açısından fark yoktu. Postoperatif ilk 24 saat fentanil tüketimi kontrol grubunda 328,5 ± 221,8 ?g ve tramadol grubunda 194,5 ± 147,4 ?g bulundu (P = 0,030). HKA bolus istek gereksinimi ise kontrol grubunda 51,2 ± 77,9 ve tramadol grubunda 20,1 ± 23,7 tespit edildi (P = 0,02). Yan etki profilleri arasında fark bulunmadı. Sonuç: Mikrodiskektomi operasyonu geçiren hastalarda epidural bölgeye uygulanan tramadol infi ltrasyonu analjezik gereksinimi belirgin ölçüde azaltmaktadır.Öğe Epidural volume expansion: is there a ceiling effect?(Edizioni Minerva Medica, 2010) Doğancı, Nur; Apan, Alparslan; Tekin, Öznur; Kaymak, C.Aim. The optimal volume of epidural saline administration on spinal anesthesia is not clear. The aim of this study was therefore to evaluate the block characteristics of 5, 10, 15, and 20 mL epidural saline after spinal anesthesia. Methods. This prospective, randomized double-blind study was conducted in the operation room setting of a university hospital. Seventy-five healthy adult patients electively undergoing limb surgery under regional anesthesia were investigated. Spinal anesthesia was performed, and plain bupivacaine (10 mg) was administered within one minute using combined spinal and epidural anesthesia. Epidural catheters were introduced, and patients were allocated to one of five groups to receive 0, 5, 10, 15 or 20 mL saline through the catheter (N=15 in each group). The patient was assessed every minute for motor and sensory block levels until a maximum level was reached. In addition, the patient was assessed thereafter in five-minute intervals using Bromage's scale for motor block and pinprick/cold sensation for sensory block. Results. The maximum level of spinal analgesia was significantly lower in the control group compared to the saline treatment groups, but there was no significant difference between the epidural saline groups. The periods for motor block resolution were the same. The duration of analgesia was significantly longer in patients receiving 15 mL, saline compared to other groups. The time to regression to the L1 level was significantly longer with 15- and 20-mL treatment groups compared to the 5- and 10-mL groups. Conclusion. The present results indicate that a ceiling effect was observed on the duration of spinal analgesia using plain bupivacaine with epidural saline loading (maximum- 15 mL). (Minerva Anestesiol 2010,76:334-9)Öğe Erratum: Surface landmarks of brachial plexus: Ultrasound and magnetic resonance imaging for supraclavicular approach with anatomical correlation (European Journal of Ultrasound 13 (3) (2001) (191-196)(2002) Apan, Alparslan; Baydar, Şenol; Yilmaz, Sevda; Uz, Aysun; Tekdemir, İbrahim; Güney, Şefik; Elhan, Alaittin[No abstract available]Öğe The evaluation of cognitive functions in desflurane anesthesia with low and high flow(2011) Kaymak, Çetin; Koçak, Orhan Murat; Babadağ, Yücel; Koçak, Emine; Apan, AlparslanObjective: Cognitive function consists of the level of consciousness, memory, orientation, concentration, general knowledge, intelligence, understanding and judgment. Postoperative cognitive dysfunction is a multifactor state which is characterized by disability of memory and concentration. At the recovery stage, the patient's cognitive functions returning to its original level is closely related with pharmacokinetics of the anesthetic material, anesthesia, desfluran used in low and high flow anesthesia. This study aimed at examining cognitive functions in the preoperative ve postoperative period when low and high flow of desfluran anesthesia was applied. Methods: After Institutional Ethics Committee approval, ASA I/II, 32 patients of 15-55 ages two groups. One group (Group I, n=16) had high flow and the other (Group II, n=I6) had low flow. Premedication was not applied. Anesthesia was induced with 1.5 ?g kg-1 fentanyl and 5-7 mg kg-1 thiopental. Endotracheal intubation was performed after 0.6 mg kg-1 rocuronium. Patients, included in Group I and in Group II were applied 4 L min-1 50 % N 2O+O2 and 1 L min-1 50 % N2O+O 2 respectively. Patient's recovery parameters were evaluated with Modified Aldrete Score (MAS) at 5., 10., 15., 30. and 60. minutes. Cognitive functions of the patients were evaluated with Verbal Auditory Memory Test (VAMT) and Stroop Interference Test (SIT). Results: No significant result was found in the preoperative and postoperative VAMT 1, VAMT 5, VAMT 6, VAMT 7, VAMT 8 and SIT scores between Group I and Group II. No correlation was confirmed between postoperative recovery time and VAMT 1, VAMT 5, VAMT 6, VAMT 7, VAMT 8, SIT score. Conclusion: Neither of the anesthetic techniques showed differences with respect to cognitive functions. We conclude that since no relationship between postoperative recovery time and cognitive functions was found, the amount of fresh gas used in the desfluran did not affect the cognitive functions.Öğe Hidrosefali ve sakral agenezi olgusunda üçlü femoral blok(2011) Apan, Alparslan; Babadağ, Yıldız; Çetik, ÖzgürHidosefali, sakral agenezi ve spina bifida anomalileri olan femur fraktürlü hastamızda, başarılı üçü bir yerde femoral sinir bloğu uygulamasını sunmayı amaçladık. Üç yaşında kız hastamızda travmatik sağ femur fraktürü mevcuttu. Klinik muayenesinde zor havayolu bulguları olan mikrognati ve makroglossi saptandı. Birlikte saptanan ileri derecede hidrosefali, alt etkstremitelerde motor paralizi, spina bifida ve sakral agenezi genel anestezi veya nöroaksiyal blok uygulamalarını güçleştirmişti. Hastamıza hafif sedasyon altında üçü bir yerde femoral blok uygulamaya karar verdik. Damar yolu bulunduktan sonra 0,05 mg kg1 intravenöz midazolam uygulandı. Femoral sinir bloğu sinir stimülasyonu tekniği ile 7,5 ml % 0,5 levobupivakain serum fizyolojik 10 ml'ye tamamlanarak uygulandı. Eksternal fiksasyon ek analjezik gereksinimi olmaksızın başarılı bir şekilde uygulandı. Hastanın vital bulguları operasyon süresi ve erken postoperatif dönemde stabil seyretti. Hasta postoperatif dönemde altı saat süre ile ağrısız bir dönem geçirdi. Periferik sinir blokları uygulama olanağı bulunduğunda güç havayolu olgularında cerrahi ve postoperatif dönem için etkili ve güvenli bir alternatif olduğu kanısındayız.Öğe In vitro antimicrobial activity of commonly used vasoactive drugs(Elsevier Science Inc, 2016) Apan, Ozgun Cuvas; Apan, Teoman Zafer; Apan, AlparslanStudy Objective: Microbial contamination during preparation of the infusion drugs is an important issue in intensive care units. Objective of this study was to investigate in vitro antimicrobial properties of commonly used vasoactive drugs. Design: Prospective study. Setting: Clinical microbiology laboratory of a university hospital. Measurements: Growth of the microorganisms Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans in saline dilutions of adrenaline at 1, 10, and 100 mu g/mL; noradrenaline at 1, 10, and 100 mu g/mL; and dopamine at 0.1, 1, and 10 mg/mL concentrations was investigated. Each drug solution and saline were analyzed with a digital pH meter. Main Results: Saline dilutions of adrenaline, noradrenaline, and dopamine at clinically used concentrations decreased microbial growth. The highest concentration doses of adrenaline, noradrenaline, and dopamine used in the study had significant antimicrobial effect when compared to the low and moderate doses. This effect was shown with the all microorganisms. S aureus, S epidermidis, and C albicans were more sensitive; on the other hand, E coli and P aeruginosa were more resistant against the effect of the drug dilutions. Conclusions: To limit microbial growth in case of contamination of the drug solution, it is advisable to use more concentrated dilutions of adrenaline, noradrenaline, and dopamine used in clinical practice. (C) 2016 Elsevier Inc. All rights reserved.
