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Öğe Anesthetic effectiveness of topical levobupivacaine 0.75% versus topical proparacaine 0.5% for intravitreal injections(Medknow Publications, 2014) Örnek N.; Apan A.; Örnek K.; Günay F.Background and Purpose: Today no method of topical anesthesia for intravitreal injection administration has been proven to make the patient comfortable yet. We compared the efficacy of topical levobupivacaine 0.75% and proparacaine 0.5% in patients undergoing intravitreal injections. Materials and Methods: A prospective, randomized study comparing two agents for topical anesthesia in intravitreal injections. Ninety-six consecutive patients were enrolled into two groups to receive either topical levobupivacaine 0.75% (n=48) or proparacaine 0.5% (n=48). Patients were asked to score their pain using a visual analog scale (VAS) immediately following the injection. The average of these scores was used as the primary outcome. The surgeon performing the procedure scored his perception of the patients? pain using the Wong-Baker FACES scale. Results: Mean VAS pain scores for two groups were found to be 44.77 ± 16.42 and 34.18 ± 14.83, respectively. Mean VAS pain score in the proparacaine group was significantly lower than that in the levobupivacaine group (P= 0.003). Mean Wong-Baker FACES scores for the two groups were 1.08 ± 0.49 and 1.10 ± 0.30, respectively. There was no statistically significant difference between levobupivacaine and proparacaine groups (P=0.824). Conclusions: Topical proparacaine 0.5% was more effective in preventing pain during intravitreal injections.Öğe Effect of paracetamol pretreatment on rocuronium-induced injection pain: A randomized, double-blind, placebo-controlled comparison with lidocaine(Journal of Clinical and Analytical Medicine, 2014) Ateş G.; Köse E.A.; Öz G.; Apan A.Aim: To compare the effect of intravenous paracetamol on rocuronium-induced injection pain with that of lidocaine. Material and Method: One hundred and eighty patients scheduled for elective surgery under general anesthesia were recruited to this prospective, randomized, double-blinded, placebo-controlled study. A 20-gauge cannula was inserted into a vein on the dorsum of the patient's left hand and lactated Ringer's solution was infused at 100 ml/h. After 5 minutes, infusion was stopped and the left arm of the patient's was elevated for 15 seconds for gravity of venous blood. While venous occlusion was applied to the left upper arm using a pneumatic tourniquet, one of the pretreatment solutions (normal saline 5 mL, lidocaine 40 mg, paracetamol 50 mg) was injected over a period of 10 seconds. The intensity of the pain patients experienced was assessed using a 4-point verbal rating scale in Group C (normal saline 5 mL, n=60), Group L (lidocaine 40 mg, n=60) and Group P (paracetamol 50 mg, n=60). After 2 minutes, the venous occlusion was released and the patients received 0.06 mg/kg rocuronim bromide over 10 seconds and the rocuronim-induced pain was assessed. Results: The overall incidence of rocuronium-induced injection pain was significantly more in Group C than the other groups (p<0.001). The overall incidence of the rocuronium-induced injection pain was significantly less in Group L than in Group P and in Group C (p=0.009 and p<0.001, respectively). Additionally, the overall incidence of the rocuronium-induced injection was less in Group P than the Group C (p=0.002). Discussion: Intravenous pretreatment with paracetamol was effective in reducing the incidence and intensity of rocuronium-induced injection pain, but not as effective as intravenous lidocaine pretreatment.Öğe The effects of cyclohexyladenosine in morphine dependent mononeuropathic rats(2001) Apan A.Opioid dependence is an important problem in the presence of chronic pain as neuropathy. The aim of present study was to determine the attenuating effect of cyclohexyladenosine (CHA) on morphine dependence and naloxone precipitated withdrawal syndrome in mononeuropathic animal model. 30 Sprague Dawley male rats weighting 185-220±15 g were included to the study. The right common sciatic nerves were ligated loosely with four 4/0 chromic gut after exploration under barbiturate anaesthesia. Animals were allocated randomly into five equal group. Drug administration and nociceptive tests were started for four days after 10 days recovery period. Saline was injected two times in a day to the control and sham operated animals. CHA 1mg/kg+saline, saline+morphine10 mg/kg and CHA 1mg/kg+morphine 10 mg/kg were administered to the other groups, respectively. Nociceptive threshold was determined during treatment period by hot plate test at 46°C. Jumping or hind limb licking of operated site was accepted as positive sign. Naloxone 1 mg/kg was administered on the 5th day, after 15 min control observation period. Escape jumping, wet dog shake or teeth chattering were determined in 15 minute period as withdrawal signs. Morphine induced analgesia was reduced by CHA. Hyperalgesia was seen on control group of rats. Anti allodynic effect was on morphine>CHA + morphine > CHA groups, respectively. CHA abolished morphine withdrawal symptoms. Adenosine agonists and morphine were effective partly on the same receptors. This study may be thought to influence further animal and clinical studies.Öğe The effects of cyclohexyladenosine on cold water swim stress (CWSS) induced analgesia(2000) Apan A.Cold 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 A.; Ozturkmen 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 diclofenac sodium on cold water swim induced analgesia (CWSS) in mice(1999) Apan A.; Ozturkmen A.It was clearly demonstrated that cold water swimming induces analgesia in mice and rats; via opioid and non-opioid mechanisms. Aim of this study is to determine the effects of diclofenac sodium (DS) on this phenomenon. 60 Swiss Webster strain albino male mice (average weight 25-35 gr) was investigated after ethic committee approval. Animals were separated into four equal groups in a randomised fashion. Normal saline (Control: C) was given to the 1st group, naloxone (NL) 100?g. kg.-1 was given to the 2nd group, diclofenac sodium (DS) 2 mg. kg.-1 was given to the 3rd group and diclofenac sodium 2 mg. kg.-1 with naloxone 100?g. kg.-1(DS+ NL) was given to the 4 th group of animals 7 minutes before CWSS test at same volumes (0.1 ml) by intraperitoneal (IP) route. After about 7 minutes, 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 maximum 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 (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 statistically significant. There were no differences between groups on basal temperature. Also, no difference were found between HPT results of C and DS; NL and DS + NL treated animals. In comparison significant differences were found between C and NL; C 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. The analgesia is decreased by NL and is not changed by DS. Study design will be constructed and directed to the tonic pain models.Öğe The effects of lactated ringer and hes solutions in differing combinations to prevent hypotension due to spinal anesthesia(2006) Şahin Ş.; Sari F.; Apan A.; Başar H.Objective: The aim of this study was to assess the effectiveness of preloading with crystalloid and colloid fluids on hypotension following spinal anaesthesia. Method: One hundred ASA Class I-II patients were randomly assigned to the study and divided into five groups. Group I: Lactated Ringer (LR) 1000 mL 30 minutes before spinal anaesthesia, Group II: HES %6 500 mL solution before the procedure, Group III: 500 mL RL before and HES %6 250 mL within 15 minutes after the procedure. Group IV and Group V received RL 500 mL + 500 RL mL, and HES %6 250 mL + HES %6 250 mL respectively, using the same timing protocol. Systolic, diastolic and mean arterial pressures and heart rates were measured at 1 minute intervals in the first 20 minutes and then every 5 minutes. Results: With the exception of the differences in diastolic blood pressures at the 2nd, 3rd, and 5th minutes, there was no difference in arterial blood pressures and heart rates between Group III and IV or Group IV and V. Conclusion: While significant correlation was found between spinal block level and the incidence of spinal hypotension, no difference was observed regarding the type, dosage, and timing of loading solutions before spinal anaesthesia.Öğe The effects of midazolam and dexmedetomidine infusion on peri-operative anxiety in regional anesthesia(American University of Beirut, 2013) Şenses E.; Apan A.; Arzu Kö?se E.; Öz G.; Rezak H.Background: This study aimed to compare the influences of midazolam and dexmedetomidine infusion on anxiety scores in patients undergoing surgery with regional anesthesia. Methods: Eighty ASA I or II class patient undergoing elective surgery with regional anesthesia were included in the study. Permanent anxiety scores were determined using the State-Trait Anxiety Inventory (STAI)-1 and 2 one day before the surgery. In Group I patients, dexmedetomidine 0.5 ?g/kg basal infusion for 10 min and 0.5 ?g/kg/h for maintenance was administered. In Group II patients, midazolam infusion at a rate of 0.05 mg/kg for 10 min and 0.05 mg/kg/h for maintenance was administered. The sedation scores were determined every 5 min. The steady state anxiety scores of the patients were determined one day before, 30 min after operation, at the end of the operation, and at 30 min and day 7 postoperatively using STAI-1 score. Side effects were determined and recorded. Results: Sedation scores were comparable in both of two treatment groups. Anxiety scores were maintained with drug infusions. The incidences of side effects were significantly decreased in midazolam group compared to the dexmedetomidine group. Conclusion: Midazolam infusion was found to be more appropriate and efficient than dexmedetomidine during regional anesthesia practice. Dexmedetomidine infusion should be cautiously used in regional anesthetic techniques performing symphathetic blockade.Öğe Surface landmarks of brachial plexus: Ultrasound and magnetic resonance imaging for supraclavicular approach with anatomical correlation(2001) Apan A.; Baydar P.; Y?lmaz S.; Uz A.; Tekdemir Y.; Güney P.; Elhan A.The present study is able to describe a certain line, under which brachial plexus (BP) lies underneath in the supraclavicular region. A line drawn between midpoint of the sternocleidomastoid muscle to the midpoint of the clavicle was considered for BP. Surface landmarks were evaluated by applying ultrasound (US) on 30 volunteers (15 female, 15 male). Axial and sagittal views of BP were taken and distances between skin and BP were measured. Coronal magnetic resonance (MR) sections were taken from 7 volunteers according to the second line after applying two fat capsules on each line. The sonographic views were seen at the same line. Mean distances from skin were found as 16.5±0.7 mm for male and 14.5±0.5 mm for female volunteers. MR images were obtained bilaterally, which were parallel and posterior from sonographic lines. Surface landmarks, as presented in this study, are simple to accomplish and are not dependent on structural variations as external jugular vein. Copyright © 2001 Elsevier Science Ireland Ltd.Öğe Three in one block in a patient with hydrocephalus and sacral agenesis(2011) Apan A.; Babadağ Y.; Çetik Ö.We aimed at presenting successful 3 in 1 femoral nerve block in a patient with hydrocephalus, spina bifida and sacral agenesis, who had femur fracture. A three years old girl has traumatic fracture on right femur. Clinical examination revealed sins for difficult airway including micrognathia and macroglossia. Giant hydrocephalus, spina bifida and sacral agenesis with motor paralysis on lower extremities were concomitant findings that might be problematic in performing general anesthesia or central nerve blocks. We therefore decided to perform 3 in 1 femoral nerve block under light sedation. Midazolam 0.05 mg kg-1 was administered via venous access and a total of 10 ml local anesthetic mixture including 7.5 ml 0.5% levobupivacaine in saline dilution was injected with increments after contractions from quadriceps muscle were elucidated. External fixation was successfully performed without complication and analgesic requirement. Vital signs were stable throughout the surgery and during the early postoperative period. Patient was pain free for six hours during the postoperative period. Peripheral nerve blocks, whenever possible are considered as efficient and safe alternative for anticipated difficult airway in both for surgery and postoperative analgesia.Öğe Time-dependent middle ear pressure changes under general anaesthesia in children: N2O-O2 mixture versus air-oxygen mixture(2013) Apan A.; Bayar Muluk N.; Güler S.; Budak B.Time-dependent middle ear pressure changes under general anaesthesia in children: N2O-O2mixture versus air-oxygen mixture. Objectives: The aim of this study was to investigate the effects of N 2O-O2 mixture (Inspired O230%) on middle ear pressure (MEP) in children compared with the effects of an air-oxygen mixture (Inspired O250%). Method: The study included thirty child patients who underwent general anaesthesia for different reasons, with the exception of ENT problems and ear interventions. They were randomly divided into two groups. Group 1(15 children: 10 male and 5 female) received a N2O-O 2 mixture (Inspired O2 30%); and group 2(15 children: 10 male and 5 female) were given an air-oxygen mixture (Inspired O2 50%). MEP was measured using a portable impedance analyser before the operation (PreO),10 minutes after intubation (10AEn), 30 minutes after intubation (30AEn), 10 minutes before extubation (10BEx), 15 minutes after the operation (PO15), 30 minutes after the operation (PO30), 1 hour after the operation (POlh) and 6 hours after the operation (PO6h). Results: The pressure and compliance values were the same in groups 1 and 2. The pressure-time graphs for the two groups were different: in Group 2, MEP rose quickly at l0AEn and positive pressure values were seen in the middle ear. MEP then fell rapidly until the end of the surgery and lower and negative pressures (Mean-50 daPa) were observed at PO6h. In Group 1, MEP was elevated at l0AEn and positive pressure was found (but not as high as in Group 2). MEP then fell more slowly. In other words, positive pressure in the middle ear persisted longer and the middle ear was subjected to positive pressure and nitrogen over a longer period. Separate analyses were made in Groups 1 and 2 of pressure differences and of compliance values at eight measurement points using the Friedman test. Differences in pressure values were found to be statistically significant in both Group 1 (p = 0.000) and Group 2 (p = 0.000). In Group 1, all the lOAEn and 30AEn values were significantly higher than the PreO, PO30, POlh and P06h values. The lOBEx value was significantly higher than the PreO and POlh values. The PO15 value was significantly higher than the PreO value. In Group 2, the PO6h value was significantly lower than the lOBEx, l00AEn and 30AEn values. The POlh value was significantly lower than the 30AEn values. The MEP values increased in Group 1 in younger and taller children and in children receiving anaesthesia for shorter periods. MEP values increased in Group 2 in younger and taller children, and in heavier children. MEP values fell with the length of anaesthesia. Conclusion: In brief anaesthesia, nitrogen was not removed from the middle ear quickly in Group 1: middle ear pressure values were higher. The nitrous oxide remained in the middle ear longer and so the possibility of ear toxicity may increase. In Group 2,50% O2was rapidly absorbed and removed from the middle ear and so middle ear pressure was not as high. It may be concluded that air-oxygen mixture (Inspired O2 50%) anaesthesia should be recommended as being more reliable in tympanoplasties and other middle ear interventions than a N 2O-O2mixture (Inspired O2 30%).
