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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 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 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.
