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Öğe Anesthesia for a child with Walker-Warburg syndrome(Elsevier Science Inc, 2014) Kose, Emine Arzu; Bakar, Bulent; Ates, Gokay; Aliefendioglu, Didem; Apan, AlpaslanBackground and objectives: Walker-Warburg Syndrome is a rare, autosomal recessive con-genital muscular dystrophy manifested by central nervous system, eye malformations andpossible multisystem involvement. The diagnosis is established by the presence of four crite-ria: congenital muscular dystrophy, type II lissencephaly, cerebellar malformation, and retinalmalformation. Most of the syndromic children die in the first three years of life because ofrespiratory failure, pneumonia, seizures, hyperthermia and ventricular fibrillation. Case Report : The anesthetic management of a two-months-old male child listed for electiveventriculo-peritoneal shunt operation was discussed. Conclusions : A careful anesthetic management is necessary due to the multisysteminvolvement. We reported anesthetic management of a two-months-old male child withWalker-Warburg Syndrome who was listed for elective ventriculo-peritoneal shunt operation. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rightsreserved.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 The effects of dexmedetomidine on renal injury induced by intra-abdominal hypertension in rats(Allied Acad, 2016) Yaman, Ferda; Boybeyi, Ozlem; Kose, Emine Arzu; Balci, Mahi; Kisa, Ucler; Apan, AlpaslanIntroduction: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are potentially life-threatening conditions in critically ill patients. Laparascopic surgery is the gold standard and has been widely performed for many procedures since its inception in the early 1980s. Pneumoperitoneum is essential for laparascopic surgery. Dexmedetomidine is a potent and highly selective alpha-2 adrenoceptor agonist with sympatholytic, sedative, amnestic and analgesic properties without respiratory depression. There is increasing evidence of its organ protective effects against ischemic and hypoxic injury, including neuroprotection, cardioprotection and renoprotection. The aim of this experimental study was to investigate the effects of the a-2 adrenoceptor agonist, dexmedetomidine on IAH induced by renal injury. Materials and methods: A total of 24 male Wistar-albino rats were randomly separated into 4 groups as the control group (CG, n=6), sham group (SG, n=6), low-dose group (DXLD, n=6) and high-dose group (DXHD, n=6). In CG, no intervention was made. IAH was obtained by insufflating atmospheric air with percutaneous intraperitoneal needle using a manual insufflator of manometer up to 15 mmHg. At the 60th min, in SG, 1.5 ml/100 gr/hr saline was infused. In DXLD, 0.5 mu g/kg/hr, and in DXHD, 1 mu g/kg/hr dexmedetomidine (Precedex, 100 mu g/ml; Abbott, Istanbul, Turkey) was infused intravenously. At the 90th min, a midline incision was made and the left kidney was harvested by median laparatomy for the measurement of tissue nitric oxide (NO), malondialdehyde (MDA) level and histopathological examination for proximal tubule injury by light microscopy. Results: No significant difference was determined between the groups either biochemically or histopathologically (p>0.05). Conclusion: Dexmedetomidine may not provide renoprotective effects within the clinical infusion doses of 0.5 mu g/kg/hr, and 1 mu g/kg/hr.Öğe Effects of Intracisternal Dexmedetomidine on Cerebral Neuronal Cells in Rat: A Preliminary Study(Turkish Neurosurgical Soc, 2013) Kose, Emine Arzu; Bakar, Bulent; Kasimcan, Omur; Atilla, Pergin; Kilinc, Kamer; Muftuoglu, Sevda; Apan, AlpaslanAIM:The aim was to investigate whether dexmedetomidine had a toxic effect on cerebral neurons when it was administered centrally into the cerebrospinal fluid by the intracisternal route. MATERIAL and METHODS: Eighteen rats were anesthetized and the right femoral artery was cannulated. Mean arterial pressures, heart rates, arterial carbon dioxide tension, arterial oxygen tension, and blood pH were recorded. When the free cerebrospinal fluid flow was seen, 0.1 ml normal saline (Group SIC, n=6) or 9 mu g/kg diluted dexmedetomidine in 0.1 ml volume (Group DIC, n=6) was administered into the cisterna magna of rats. After 24 hours, the whole body blood was collected for measurement of plasma lipid peroxidation (LPO) levels. The hippocampal formations used for histopathological examination and measurement of tissue LPO levels. RESULTS: There was a statistically significant difference between the DIC/SIC groups and DIC/CONTROL groups regarding the brain LPO levels (p=0.002, p<0.001, respectively). Plasma LPO levels were statistically different between the CONTROL/DIC groups, CONTROL/SIC groups, DIC/ SIC groups (p=0.002, p=0.047, p=0.025, respectively),The picnotic neuron counts were different between the CONTROL/SIC groups, CONTROL/ DIC groups, DIC/SIC groups (p<0.001, p=0.001, p=0.024, respectively). CONCLUSION: In conclusion, dexmedetomidine had a toxic effect on cerebral neurons when it was administered centrally into the cerebrospinal fluid by the intracisternal route.Öğe Effects of Low Dose Methotrexate in Cerebral Ischemia Reperfusion Injury in Rat(Journal Neurological Sciences, 2015) Bakar, Bulent; Kose, Emine Arzu; Sari, Elif; Sarkarati, Bahram; Atasoy, PinarBackground: During cerebral ischemia reperfusion injury, oxidative stress leads to excitotoxicity, blood brain barrier dysfunction and inflammation. This study was designed to evaluate possible protective effects of low dose methotrexate on cerebral transient ischemia reperfusion injury in rat. Methods: Except CONTROL group, temporary aneurysm clips were performed to both common carotid arteries of rats for duration of 30 minutes. Four hours later, except CONTROL and SHAM groups, methotrexate (1.25 mg/kg/day) was administered intraperitoneally. Seventy two hours later, animals of CONTROL, MTX-A and SHAM-A group; and ten days later animals of MTX-C and SHAM-C group were sacrificed and hippocampal pyknotic neuronal cell count results and tissue lipid peroxidation (LPO) values were analyzed statistically. Results: Pyknotic cell count values of CONTROL group were lower than SHAM-A, SHAM-C, MTX-A and MTX-C group values. Cell count values of SHAM-A and MTX-A group were higher than SHAM-C and MTX-C values, respectively. LPO values of CONTROL group were lower than SHAM-A and MTX-A values, but not different from MTX-C and SHAM-C values. LPO values of MTX-A group higher than MTX-C group values. Conclusion: Cell count values and LPO values demonstrated that low dose methotrexate could not prevent neuronal cells from destructive effects of transient ischemia reperfusion injury in rat.Öğe Effects of low-dose methotrexate in spinal cord injury in rats(Turkish Assoc Trauma Emergency Surgery, 2013) Bakar, Bulent; Kose, Emine Arzu; Kupana Ayva, Sebnem; Sarkarati, Bahram; Kasimcan, Mustafa Omur; Kilinc, KamerBACKGROUND This study was designed to evaluate the possible protective effects of low-dose methotrexate in the spinal cord injury (SCI) in rats. METHODS Thirty-seven Wistar albino rats were used in the present study. Except for the animals of the Sham group, all animals were divided into two main groups, which were used in acute and subacute stage investigations. Then, thoracal laminectomy was performed, and except for the Sham group, SCI was induced using a temporary aneurysm clip. After clip compression, the experimental material (methotrexate or methylprednisolone) was administered intraperitoneally, except in the Sham and Control groups. Then, the spinal cords were removed to evaluate the SCI histopathologically and biochemically at the scheduled date. RESULTS Neither experimental material was shown to reduce the histopathological grade in either stage of SCI. Low-dose methotrexate was shown to decrease lipid peroxidation levels only in the subacute stage of SCI. However, methylprednisolone and low-dose methotrexate could not decrease or block myeloperoxidase enzyme activation in either stage of SCI. CONCLUSION Low-dose methotrexate was effective in reducing the lipid peroxidation levels in the subacute stage of SCI, although histopathological evaluation results and myeloperoxidase levels of all groups did not support this finding at either stage.Öğe The effects of pressure-controlled and volume-controlled ventilation modes on the nasal mucociliary activity during general anaesthesia.(Allied Acad, 2017) Yaman, Ferda; Arslan, Bengi; Kose, Emine Arzu; Kilic, Rahmi; Apan, AlpaslanThe aim of this prospective randomized, double-blind study was to investigate the effects of pressure controlled and volume controlled ventilation on mucociliary clearance under general anaesthesia maintained with total intravenous anaesthesia. After approval by the Ethics Committee, 60 patients scheduled for tympanoplasty or tympanomasteidectomy under general anaesthesia were enrolled in the study. In Group I (n=30), the lungs of the patients were ventilated using volume-controlled mode with 8 ml/kg tidal volume. In Group II (n=30) pressure controlled ventilation mode was used with 10 cm H2O pressure support. Mucociliary clearance was assessed by in vivo saccharine transit time in preoperative and postoperative periods. The groups showed no significant differences regarding age, height, body mass index, peak and plateau airway pressures. Saccharine transit time values did not differ significantly between the groups. In conclusion, volume-controlled and pressure-controlled ventilation modes have no significant impact on nasal saccharine transit time.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 Evaluation of the neurotoxicity of DMSO infused into the carotid artery of rat(Elsevier Sci Ltd, 2012) Bakar, Bulent; Kose, Emine Arzu; Sonal, Sevilay; Alhan, Aslihan; Kilinc, Kamer; Keskil, Ismail SemihIntroduction: Despite the explanations put forth in many studies regarding histopathological evidence of the inflammatory stage related with the infusion of dimethyl sulfoxide (DMSO) in the vessel wall and its lumen, there has been no research to evaluate its neural toxicity when it is infused via the intracarotid route. This study was designed to evaluate the possible neurotoxic effects of DMSO on the closer and distant brain tissue and carotid artery when it was slowly infused into the internal carotid arteries of the rats. Methods: The right common carotid artery bifurcation was exposed through a midline neck incision, and then except those of the control group animals (n = 5), the experimental material (normal saline, n = 5 or anhydrous DMSO, n = 10) was infused into the internal carotid artery of the Wistar albino rats. After the experimental materials were administered intra-arterially, brain tissues were harvested for histopathological and biochemical studies at 72 h for investigation of the acute stage changes and on 10th day for investigation of the chronic stage changes. Internal carotid arteries of both sides were also removed for histopathological evaluation. During sacrification of the rats, whole body blood of them are collected for biochemical evaluation. Results: There was no statistically significant difference between the groups regarding comparison of the mean values of the hippocampal neuronal cell counts and the carotid artery diameters in both acute and chronic stages. Also, mean values of the lipid peroxidation levels of harvested brain tissues and serums of the collected bloods were similar in control, saline and DMSO groups. Conclusion: This experimental study suggested that DMSO has no toxic effect on the neural and arterial tissues of rats when it is slowly infused into the carotid artery. (C) 2011 Elsevier Ltd. All rights reserved.Öğe Evaluation of the Neurotoxicity of the Polyethylene Glycol Hydrogel Dural Sealant(Turkish Neurosurgical Soc, 2013) Bakar, Bulent; Kose, Emine Arzu; Balci, Mahi; Atasoy, Pinar; Sarkarati, Bahram; Alhan, Aslihan; Keskil, Ismail SemihAIM: Although polyethylene glycol (PEG) is a neutral, biocompatible hydrophilic polymer recognized for its lack of interaction with biological barrier, its neurotoxicity has not been clearly identified in neurosurgery. This study is constructed to evaluate the possible neurotoxicity of a PEG hydrogel dural sealant. MATERIAL and METHODS: After a burrhole was opened in the left parietal bone of the twenty five Wistar albino rats, the dura mater and cerebral cortex were incised and the experimental material (activated polyethylene glycol and polyethylene imine) was sprayed into the burrhole. Then brain tissues were harvested for histopathological and biochemical studies at 72 hours to investigate the acute stage changes and on 15th day to evaluate the chronic stage changes. RESULTS: There were statistically significant differences among the groups regarding the comparison of the values of the PMNL cell infiltration grades, gliosis and congestion in both acute and chronic stages. However, the values of the MNL cell infiltration grades, edema and fibrin formation, lipid peroxidation levels of harvested brain tissues were similar in all groups. CONCLUSION: Although this study did not present the detailed histopathological and biochemical evaluation results, it indicated that the application of the PEG-based hydrogel sealant was not associated with neurotoxicity, delayed healing, or degenerative changes.Öğe In Vitro Effect of Dexmedetomidine on Platelet Aggregation(Elsevier Science Inc, 2013) Kose, Emine Arzu; Nevruz, Oral; Honca, Mehtap; Yildirim, VedatBackground and objectives: Dexmedetomidine is a selective alpha(2)-agonist. There are 250-300 alpha(2)-agonist-adrenoceptor on the surface of each human platelet and ephedrine induces platelet aggregation by binding these receptors. This study was designed to study platelet function after incubation with therapeutic concentrations of dexmedetomidine. Methods: The study was carried out on 18 healthy, non-smoking males, ages ranging 25 to 35 years old. Because of the recommended therapeutic concentration range of dexmedetomidine obtained by intravenous infusion is 0.4-1.2 ng.mL(-1), dexmedetomidine solutions were prepared in three different concentrations. The calculated value of dexmedetomidine solution and diluent without dexmedetomidine as control were added to the blood sample. Thus, we obtained 0, 0.4, 0.8 and 1.2 ng.mL(-1) dexmedetomidine concentrations of plasma. Each concentration of dexmedetomidine was incubated with whole blood at 37 degrees C during 15 minutes. Then blood samples were centrifugated to prepare platelet-rich plasma and platelet-poor plasma. The platelet-rich plasma was diluted with the platelet-poor plasma to yield test platelet-rich plasma with a final platelet count of 250 +/- 50 X 10(9).L-1. Results: The platelet aggregation amplitudes and slopes were statistically similar among all groups by the aggregation test, which were performed with ADP, collagen or epinephrine. Conclusion: Therapeutic concentrations of dexmedetomidine had no effect on the platelet functions in healthy individuals in vitro. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.Öğe Preoperative exercise heart rate recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery(Elsevier Science Inc, 2012) Kose, Emine Arzu; Kabul, Hasan Kutsi; Yildirim, Vedat; Tulmac, MuratStudy Objective: To assess the predictive role of heart rate (HR) recovery in the detection of intraoperative hypotension in patients undergoing noncardiac surgery. Design: Prospective, observational study. Setting: Department of cardiology and operating rooms of university hospitals. Patients: 160 ASA physical status 1 and 2 patients scheduled for elective noncardiac surgery. Measurements: All patients underwent exercise stress testing. Maximum HRs and metabolic equivalent levels were recorded. Heart rate recovery at the first, second, and third minutes were calculated by subtracting HRs one, two, and three minutes into the recovery period from the maximal HR at peak exercise. A decrease in mean arterial pressure (MAP) of greater than 30% was defined as intraoperative hypotension and recorded. Patients were classified to two groups according to whether they had intraoperative hypotension. Main Results: Hypotensive episode was observed in 31 patients (19.7%) during the operation. The presence of diabetes mellitus was higher in patients with intraoperative hypotension (22.6% vs 7.1%, P = 0.019). Mean HR recovery at the first, second, and third minutes was significantly lower in the intraoperative hypotension group (P = 0.001, P = 0.004, and P = 0.031, respectively). Heart rate recovery at the first, second, and third minutes was a good predictor of intraoperative hypotension, but only HR recovery at the first minute (OR 0.82, 95% CI 0.73 to 0.92, P = 0.001) and HR recovery at the second minute (OR, 0.90; 95% CI, 0.82 to 0.98; P = 0.019) were independent predictors of intraoperative hypotension. A higher negative correlation was noted between the degree of MAP reduction and HR recovery at the first minute (r = -0.797, P = 0.001). Conclusions: Abnormal preoperative exercise HR recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery. Given the importance of intraoperative hypotension, preoperative use of exercise testing might be considered. (c) 2012 Elsevier Inc. All rights reserved.
