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Öğe Comparison of Effects of Dexmedetomidine-ketamine and Dexmedetomidine-midazolam Combinations in Transurethral Procedures(Elsevier Science Inc, 2012) Köse, Emine Arzu; Honca, Mehtap; Yılmaz, Erdal; Batislam, Ertan; Apan, AlpaslanOBJECTIVE To compare the effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations on the recovery time, hemodynamic and respiratory variables, and side effects in patients undergoing transurethral procedures. METHODS Sixty patients scheduled for elective outpatient transurethral procedure were randomized into 2 groups. In the group K, a ketamine-dexmedetomidine combination was administered, and in the group M, midazolam-dexmedetomidine was administered, to provide sedation/analgesia. Pain and sedation levels were assessed using visual analog score (VAS) and Ramsey Sedation Scale, respectively. The recovery time was assessed with the scale of Aldrete. Time was measured and recorded to the moment at which patient responses brought the Aldrete score to 10 points. Time to eye opening and length of stay in the recovery room were recorded. RESULTS Group M showed significantly lower mean arterial pressure (MAP) values at 5 and 10 minutes during the procedure when compared with group K (P = .02 and P = .01, respectively). Visual analogue scale scores were greater in group M than in group K at 5 and 10 minutes for the transurethral procedure (P = .039 and P = .028, respectively). Sedation scores were similar between groups during the procedure. Time to eye opening and length of recovery room stay were shorter (P < .001 and P < .001, respectively), and Aldrete scores were greater in group K than group M. CONCLUSION Both combinations provided satisfactory sedation levels, but the dexmedetomidine-ketamine combination provided better analgesia and hemodynamic stability, with less nausea and vomiting and shorter recovery time, than the dexmedetomidine-midazolam combination. UROLOGY 79: 1214-1219, 2012. (c) 2012 Elsevier Inc.Öğe Effects of Intracisternal and Intravenous Dexmedetomidine on Ischemia-Induced Brain Inj ury in Rat: A Comparative study(2013) Köse, Emine Arzu; Bakar, Bülent; Kasımcan, Mustafa Ömür; Atilla, Pergin; Kılınç, Kamer; Müftüoğlu, Sevda Fatma; Apan, AlpaslanAMAÇ: Sıçanlarda inkomplet serebral iskemisi üzerine intrasisternal yolla verilen deksmedetomidinin etkilerinin intravenöz yolla verilen deksmedetomidinin etkileriyle karşılaştırılması amaçlandı. YÖNTEM ve GEREÇLER: Ortak sağ karotid arter oklüzyonu ve hemoraj ik hipotansiyon ile 30 dakika süreyle serebral iskemi oluşturuldu. İntrasisternal gruplarda, iskemiden 30 dakika önce sisterna magna içine 0,1 ml % 0.9 NaCl (Grup SIC, n6) veya 9 µg/kg deksmedetomidin (Grup DIC, n6) verildi.İntravenöz gruplarda ise 9 µg/kg deksmedetomidin (Grup DIV, n6) veya % 0,9 NaCl (Grup CONTROL, n6) 5 ml/kg/h hızla 2 saat süreyle infüze edildi. Yirmi dört saat sonra beyin dokusunda ve plazmada lipid peroksidasyon seviyeleri ölçüldü. Histopatoloj ik incelemeler için hipokampal yapı kullanıldı. BULGULAR: İntravenöz deksmedetomidin ortalama arteriyel basınç ve plazma glukoz seviyelerinde bazale göre bir düşüşe neden oldu. Grup DIV ile Grup DIC, Grup SIC ve CONTROL grupları arasında beyin dokusu lipid peroksidasyon seviyeleri ve piknotik hücre sayıları bakımından anlamlı farklılık vardı (sırasıyla; p0,001, p0,001, p0,001 ve p0,001, p0,01, p0,009). Grup DIV için ortalama plazma lipid peroksidasyon seviyeleri Grup DICınkinden farklı bulundu (p0,003). SONUÇ: İskeminin indüklediği nöronal hasarda sistemik yolla verilen deksmedetomidinin nöroprotektif etkisi varken santral yolla verilen deksmedetomidinin nöroprotektif etkisi yoktur.Öğe Effects of Intracisternal and Intravenous Dexmedetomidine on Ischemia-Induced Brain Injury in Rat: A Comparative Study(Turkish Neurosurgical Soc, 2013) Köse, Emine Arzu; Bakar, Bülent; Kasımcan, Ömür; Atilla, Pergin; Kılınç, Kamer; Muftuoğlu, Sevda; Apan, AlpaslanAIM: To compare the effect of dexmedetomidine administered by intracisternal route with by intravenous route on brain tissue of rat after incomplete cerebral ischemia. MATERIAL and METHODS: Cerebral ischemia was produced by the combination of right common carotid artery occlusion and hemorrhagic hypotension during 30 minutes. Thirty minutes before the ischemia, 0.1 ml 0.9% NaCl (Group SIC, n=6) or 9 mu g/kg dexmedetomidine (Group DIC, n=6) was administered into the cisterna magna. For the intravenous groups, 9 mu g/kg dexmedetomidine (Group DIV, n=6) or 0.9% NaCl (Group CONTROL, n=6) 5 ml/kg/h was given in 2 hours. After 24 hours, the lipid peroxidation levels were measured in the brain tissue and plasma. Hippocampal formations were used for histopathological examination. RESULTS: Intravenous dexmedetomidine produced a decrease in baseline mean arterial blood pressure and plasma glucose concentrations. There was a significant difference between the DIV group and DIC, SIC, CONTROL groups regarding the brain lipid peroxidation levels (p<0.001, p<0.001, p=0.001, respectively), and regarding the picnotic neuronal cell count (p<0.001, p=0.01, p=0.009, respectively). Mean plasma lipid peroxidation levels of the DIV group was different from the DIC group (p=0.003). CONCLUSION: Systemically administered dexmedetomidine had neuroprotective effect in ischemia-induced neuronal damage, but centrally administered dexmedetomidine did not.Öğe Neuroprotective effects of racemic ketamine and (S)-ketamine on spinal cord injury in rat(Elsevier Sci Ltd, 2012) Köse, Emine Arzu; Bakar, Bülent; Ayva, Şebnem Kupana; Kılınç, Kamer; Apan, AlpaslanBackground: The aim of this study was to investigate and to compare the potential neuroprotective effects of racemic ketamine, (S)-ketamine and methylprednisolone after an experimental spinal cord injury model in rats. Methods: Fifty-nine Wistar albino rats were divided into three main groups as acute stage (A), subacute stage (SA) and sham groups and then acute and subacute stage groups were divided into four groups regarding the used drug as control (CONT), racemic ketamine (RK), (S)-ketamine (SK) and methylprednisolone (MP) groups. A dorsal laminectomy was performed; and spinal cord injury was induced by using a temporary aneurysm clip. Four hours later from the clip compression, except those of the sham and control groups, the drugs (60 mg/kg racemic ketamine, 60 mg/kg (S)-ketamine or 30 mg/kg methylprednisolone) were administered intraperitoneally. At 72th h and 7th days of the study, the spinal cords of rats were removed from T8 level to the conus medullaris level. The specimens were and evaluated histopathologically, tissue lipid peroxidation (LPO) and myeloperoxidation (MPO) levels were measured and biochemically. Results: The histopathological results were similar both in the acute and in the subacute stage groups. There was a statistically significant difference among all groups regarding the tissue LPO levels (p < 0.001). There was a statistically significant difference between the CONT-A group and the MP-A, RK-A and SK-A groups (p = 0.004, p < 0.001 and p = 0.007, respectively) in acute stage and between the CONT-SA group and SK-SA group (p = 0.002) in subacute stage. There was a statistically significant difference among all groups regarding the tissue MPO levels (p = 0.001). The median MPO levels were similar among acute stage groups (p = 0.057), but there was a statistical difference among subacute stage groups (p = 0.046). Conclusion: (S)-ketamine is more effective than methylprednisolone and racemic ketamine to reduce the LPO levels in subacute stage of spinal cord injury in rats. And, it is as effective as methylprednisolone in preventing secondary spinal cord injury histopathologically. (c) 2012 Elsevier Ltd. All rights reserved.Öğe Pre-versus postoperative tramadol instillation: both are effective for decreasing pain and/or agitation in pediatric adenotonsillectomy(2013) Aydın, Gülçin; Apan, Alparslan; Köse, Emine Arzu; Öz, GökşenAim: The present study aimed to investigate the possible influence of nasopharyngeal preoperative or postoperative tramadol instillation on postoperative pain and agitation in pediatric patients undergoing adenoidectomy, with or without tonsillectomy and tube placement. Materials and methods: Ninety pediatric patients were included in the study. Induction of anesthesia was achieved with 2.5 mg kg−1 propofol and 0.6 mg kg−1 rocuronium bromide. To maintain the anesthesia, 2%–2.5% sevoflurane in an oxygen-N2 O mixture (FiO2 = 35%) was administered. In Group I (n = 30), 1 mg kg−1 tramadol was given 10 min before adenoidectomy, and in Group II (n = 30) it was administered 10 min after adenoidectomy was achieved on the adenoid tissue. Saline, at the same volume, was injected as a control in Group III (n = 30). Patients were evaluated for postoperative pain, agitation score, and modified Aldrete score (MAS) in recovery. Results: When compared with the treatment groups, pain scores and analgesic requirements in the control group significantly increased (P < 0.001). Agitation scores were also significantly higher in the same group. Time-related MASs were significantly lower in the control group in the early recovery period. Conclusion: Preoperative or postoperative tramadol instillation administered to the adenoidectomy area significantly decreased postoperative analgesic requirements and agitation.
