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Öğe Anesthetic Risks Associated With Antley-Bixler Syndrome(Lippincott Williams & Wilkins, 2013) Gencay, Isin; Vargel, Ibrahim; Buyukkocak, Unase; Yazici, Ilker; Apan, AlpaslanAntley-Bixler syndrome is an autosomal recessive disorder characterized by multiple bone and cartilaginous abnormalities. The main features of this syndrome include brachycephaly, midface hypoplasia, dysplasia of ears and nose, radiohumeral synostosis, choanal stenosis, or atresia. Distinctive features are based on craniofacial deformity and humeroradial synostosis. In this report, we describe the anesthesia management of a 20-year-old Antley-Bixler syndrome patient who underwent maxillary advancement via Le Fort I osteotomy. During surgical management of craniofacial syndrome patients, particularly Antley-Bixler syndrome, the whole surgical team should be aware of possible deformities involving the airway, which may be underestimated or nondetected prior to surgery. These deformities including choanal atresia/stenosis may lead to failure of nasotracheal intubation and mask ventilation, therefore jeopardizing the surgical procedure and/or patient safety. Accurate preoperative preparation and being aware of the components of this syndrome is vital to eliminate respiratory complications and enable uneventful anesthetic and surgical management.Öğe Comparison of Epidural Ropivacaine 0.2% and Ropivacaine 0.2% in Combination with Sufentanil 0.75 ?g mL-1 for Postcaesarean Analgesia(Kare Publ, 2008) Kaya, Tahsin; Buyukkocak, Unase; Basar, Hulya; Sagsoz, NevinAnalgesic techniques after c-section must be effective producing early mobilisation to enable mothers to care effort their babies. In this study, the comparison of ropivacaine 0.2% alone, with ropivacaine 0.2%+sufentanil 0.75 microg mL-1 for patient controlled epidural analgesia (PCEA) was aimed. Fifty women (ASA-I) were enrolled in the study. All patients had combined spinal-epidural anaesthesia. Infusion of analgesic solutions was started when sensory level decreased by two dermatome levels. The patients randomly assigned, into two groups (n=25). In Group-I, ropivacaine 0.2% and sufentanil 0.75 microg mL-1, in Group-II, ropivacaine 0.2% alone were applied (bolus 1.25 mL, lockout 30 min, with 2.5 mL h-1 background infusion). Pain (Visual Analog Scale), motor blockage (Bromage scale) and sedation (Four point scale) were evaluated during 24 hours after Caesarean, using the scales of visual analogue, bromage, and four-point, respectively. Haemodynamic and respiratory parameters, side effects, total drug consumption and additional analgesic need, were recorded. Statistical analysis included student-t, chi-square, and Mann Whitney U tests. There was no difference in demographic data, sedation scores, haemodynamic and respiratory parameters, between the groups. Motor block and pain scores were significantly higher in Group-II than in Group-I at 2 and 4. h. Total drug consumption was 65.24+/-4.20 mL for Group-I and 81.1+/-6.44 mL for Group-II, (P<0.05). Four patients in Group-I and 21 patients in Group-II received additional analgesic. Pruritus was observed more frequently in Group-I. The addition of sufentanil 0.75 microg mL-1 to ropivacaine 0.2% for PCEA after Caesarean led to more effective analgesia and less motor weakness when compared to ropivacaine 0.2% alone, especially during early postoperative period.Öğe Dexmedetomidine as an Alternative Anesthetic Agent for Flap Surgery: An Intravital Evaluation in the Cremaster Muscle Flap(Lippincott Williams & Wilkins, 2019) Gencay, Isin; Boybeyi, Ozlem; Unlu, Gulhan; Yazici, Ilker; Aydin, Gulcin; Buyukkocak, UnaseIntroduction: Flap surgery is one of the most commonly used techniques of reconstructive surgery for effective repair of damaged tissue. Optimal anesthetic technique and anesthetic agent plays an important role in flap perfusion. This study aimed to evaluate the effects of dexmedetomidine infusion on the microcirculation in the cremaster muscle flap by direct in vivo monitoring. Materials and Methods: We randomly divided 9 Wistar albino rats into 3 groups. The rats in the control group underwent the surgical procedure (isolation of the cremaster muscle) alone; the rats in the experimental groups 1 and 2 received an infusion of dexmedetomidine (10 and 30 min) after the surgical procedure. Results: The means of vessel diameters, number of functional capillaries, and movements of leukocytes in all groups were evaluated using intravital microscopic examination. The diameters of the arterioles and venules of the cremaster muscle significantly increased in the dexmedetomidine groups. The number of functional capillaries was higher in the dexmedetomidine groups than in the control group. No difference was observed in the movements of leukocytes between the control and experimental groups. Dexmedetomidine significantly increased the diameters of the arterioles and venules of the cremaster flap and the number of functional capillaries. Conclusion: On the basis of the effects of dexmedetomidine on microcirculation, we suggest that dexmedetomidine continue to be used as an anesthetic agent, and may be considered also for reconstructive procedures, particularly flap surgery.Öğe The effect of insulin resistance on mortality in critically ill patients in the intensive care unit(INDIAN ANAESTHETISTS FORUM, 2020) Bakkal, Ayse Gulcan; Buyuksekerci, Murat; Gencay, Isin; Aydin, Gulcin; Caglayan, Osman; Buyukkocak, UnaseBackground and Aims: Insulin resistance can be described as a subnormal biological response to a specific insulin concentration or deterioration of an accepted response to insulin in glucose homeostasis and deficiency of insulin response. The aim of this study is to evaluate the effect of insulin resistance on mortality in critically ill patients. Methods: Over 18-year-old and nondiabetic 150 patients that had been hospitalized in an intensive care unit (ICU) between September 2013 and October 2014 were enrolled in this study. The Acute Physiology and Chronic Health Enquiry II (APACHE II), Glasgow Coma Scale, and Richmond Agitation and Sedation Scale were calculated on the day of admission to the ICU, and following 4th day and 1st, 2nd, 3rd, and 4th weeks. Insulin resistance was calculated using the HOMA formula. Infection and other complications during ICU stay, the requirement of mechanical ventilation (MV), nutritional status (parenteral and/or enteral), vasopressor, steroid, and insulin treatment were also recorded. Patients followed in the ICU were recorded as survivors and nonsurvivors. Results: Glucose levels were found to be higher in nonsurvivor group at the 1st week and there was a significant positive relationship between APACHE II score and insulin resistance at the 3rd week. There was a significant relationship between mortality and requirement of MV, vasopressor medication, complications, and infection. Conclusion: We conclude that the effect of insulin resistance seems to affect the mortality in critically ill patients after at least a 3 weeks long follow-up time.Öğe The effects of preanesthetic, single-dose dexmedetomidine on induction, hemodynamic, and cardiovascular parameters(Elsevier Science Inc, 2008) Basar, Hülya; Akpinar, Serpil; Doganci, Nur; Buyukkocak, Unase; Kaymak, Cetin; Sert, Ozgur; Apan, AlpaslanStudy Objectives: To investigate the hemodynamic, cardiovascular, and recovery effects of dexmedetomidine used as a single preanesthetic dose. Design: Randomized, prospective, double-blind study. Setting: University Hospital of Kirikkale, Kirikkale, Turkey. Patients: 40 ASA physical status I and II patients, aged 20 to 60 years, who were scheduled for elective cholecystectomy. Interventions: Patients were randomly divided into two groups to receive 0.5 mu g kg(-1) dexmedetomidine (group D, n = 20) or saline solution (group C, n = 20). Anesthesia was induced with thiopental sodium and vecuronium, and anesthesia was maintained with 4% to 6% desflurane. Measurements: Mean arterial pressure (MAP), heart rate (HR), (ejection fraction (EF), end-diastolic index (EDI), cardiac index (CI), and stroke volume index (SVI) were recorded at 10-minute intervals. The times for patients to "open eyes on verbal command" and postoperative Aldrete recovery scores were also recorded. Main Results: In group C, an increase in HR and MAP occurred after endotracheal intubation. In group D, HR significantly decreased after dexmedetomidine was given. The EDI, Cl, SVI, and EF values were similar in groups D and C. The modified Aldrete recovery scores of patients in the recovery room were similar in groups C and D at the 15th minute. Conclusions: A single dose of dexmedetomidine given before induction of anesthesia decreased thiopental requirements without serious hemodynamic effects or any effect on recovery time. Crown Copyright (C) 2008 Published by Elsevier Inc. All rights reserved.Öğe In vitro antibacterial effects of topical local anesthetics(Taylor & Francis Ltd, 2008) Sedef Gocmen, J.; Buyukkocak, Unase; Caglayan, Osman; Aksoy, AltanBackground: The antibacterial activities of local anesthetics are recognized. Objective: To investigate in vitro the activity of topical local anesthetic ointments at clinical doses. Methods: The activity of two different local anesthetic ointments including lidocaine 5% and lidocaine/prilocaine 2.5% was tested against Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, Streptococcus pyogenes and Enterococcus faecalis by the disc-diffusion method. Sterile discs containing topical local anesthetic drugs were prepared taking into account the doses of ointments used in clinical practice. The validity of the methodology was confirmed using topical antibacterial mupirocin. The inhibition zones of the discs were measured. Results: Mupirocin inhibited all the bacteria. Both local anesthetic ointments were found to be most effective on E. coli, whereas they had no effects on P. aeruginosa. Lidocaine 5% revealed antibacterial activity against S. aureus, S. epidermidis, E. coli, S. pyogenes and E. faecalis, but lidocaine/prilocaine 2.5% showed no activity on E. faecalis and inhibited S. pyogenes only at double doses. It was also observed that the antibacterial activity was in a dose-dependent manner. Conclusion: In the light of these findings, it might be concluded that topical local anesthetic ointments in routine settings may have a preventive role against some bacteria.Öğe In Vitro Investigation of the Antibacterial Effect of Ketamine(Taylor & Francis Ltd, 2008) Gocmen, Sedef; Buyukkocak, Unase; Caglayan, OsmanBackground: Antibacterial activity of local anesthetics especially lidocaine has been shown previously. In this study, the antibacterial effect of ketamine, a general anesthetic agent was investigated. Methods: The antibacterial effect of ketamine was studied using six different strains of bacteria (Staphylococcus aureus, Staphylococcus epidermidis, Entecoccus faecalis, Streptococcus pyogenes, Pseudomonas aeruginosa and Escherichia coli) with disc diffusion method. Ciprofloxacine discs (CIP, oxoid) were used as a control to verify the methodology. Minimal inhibition concentration (MIC) and minimal bactericidal concentration (MBC) of ketamine for these bacteria were also determined. Results: No inhibition was evident in discs containing 62.5 mu g of ketamine. Ketamine 125 mu g showed activity on all the bacteria tested with the exception of E. coli. The inhibition rates of Ketamine were more prominent at the doses of 250 mu g and 500 mu g similar to the inhibition rate of CIP. Whereas MIC and MBC values of ketamine for S. aureus and S. pyogenes were 500 mu g mL(-1), MIC and MBC values for P. aeruginosa were above 2000 mu g mL(-1). For other bacteria, these values ranged between these levels. Conclusions: Ketamine with higher doses showed antibacterial activity. We thought that it will be proper to use ketamine hesitantly in experimental animal studies like sepsis and translocation.Öğe A novel approach for brachial plexus block(Tubitak Scientific & Technical Research Council Turkey, 2009) Apan, Alpaslan; Basar, Huelya; Sahin, Saziye; Buyukkocak, UnaseAim: The line from the midpoint of the sternocleidomastoid muscle to the midpoint of the clavicle was considered the surface projection of the brachial plexus in the supraclavicular region in a previous report using radiological and anatomic techniques. The needle insertion site was the point between the clavicular one-third and cervical two-thirds of this line. The aim of the present study was to determine the clinical efficacy of these suggested landmarks. Materials and methods: Brachial plexus block was performed in 60 healthy adult patients undergoing elective Surgery on an upper extremity using the above-mentioned new surface landmarks. Results: The characteristics of the block resemble those in the interscalene technique. Brachial plexus block was performed with a high success rate (98.5%) and minor complications including phrenic nerve palsy (45%), Horner syndrome (15%), and recurrent nerve block (1.6%). No major complication such as pneumothorax or accidental intravascular insertion was observed. Conclusion: The new landmarks were not dependent on patients' physical features or deeper anatomic structures. The surface landmarks based on bony prominences were defined easily. Brachial plexus block was performed with a high success rate and is considered a safe alternative to the classically described techniques.
