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Öğe Analgesic efficacy of ultrasound guided paravertebral block in percutaneous nephrolithotomy patients: a randomized controlled clinical study(BMC, 2020) Yaman, Ferda; Tuglu, DevrimBackground: Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCN). Methods: A total of 44 patients, falling in categories I to III of the American Society of Anesthesiologists, and aged between 18 and 65 years, who were scheduled for PCN, were randomly distributed into two groups. The anaesthetic intervention group (PVB) contained 22 individuals, who were injected at level T8-T9 with 20 mL 0.25% bupivacaine as a single administration. In the control group C, also containing 22 individuals, the intervention was not carried out The groups were compared after PCN in terms of opioid use, pain score, opioid adverse effects profile and the need for supplemental analgesia. Results: Visual analogue scale pain scores whilst at rest or moving were lower at the level of statistical significance in the PVB group compared to controls at 2 and 4 h post-surgery. At 6 and 8 h post-surgery, the control group had a lower VAS score when moving, and this result reached statistical significance (p < 0.05). The controls used more opioid relief than the PVB group and had lower scores for satisfaction (p < 0.05). Conclusion: Ultrasound-guided PVB using bupivacaine and an in-plane technique provides effective analgesia in PNL. It is associated with high scores on patient satisfaction and minimal complications.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 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 Effects of Semi-Fowler Position on Cerebral Oxygenation During Thyroidectomy(2020) Yaman, Ferda; Pehlivanlı, Faruk; Aydın, GülçinPatients are positioned with hyperextension of head and neck at Semi-Fowler state during general anaesthesia to facilitatethe surgical procedure. We aimed to determine the changes of serebral oxygenation in this position during thyroidectomy surgery.22 patients were recruited prospective observational study. Cerebral oxygenation were monitored, left and right cerebral regionaloxygen saturation were measured continuously. Heart rate, mean arterial pressure, end-tidal carbondioxide were measured andevaluated at baseline, after positioning at 15th, 30th, 90th minutes and after surgery at corrected position. After 90 minutes,significant decrease was seen cerebral oxygenization right side compared to the baseline (p ? 0.05). 30th minute cerebraloxygenization right value decreased significantly compared to the 15th minute. 30th minute, cerebral oxygenization left valuedecreased significantly compared to 15 minutes (p ? 0.05). 90th minute cerebral oxygenization left value decreased significantlycompared to the 30th minute (p < 0.05). Significant decrease in cerebral oxygen saturation in both cerebral sides had been shown inrelation to prolonged surgery time. Cerebral oxygenation was effected by the position given for thyroidectomy surgery. High-riskpatients can be detected by regional cerebral oxygen saturation and prevent cerebral ischemia. Precautions should be taken for highrisk patients.Öğe Evaluation of the systemic antiinflammatory effects of levosimendan in an experimental blunt thoracic trauma model(2017) Ateş, Gökay; Yaman, Ferda; Bakar, Bülent; Kısa, Üçler; Büyükkoçak, Ünase; Atasoy, PınarBACKGROUND: Blunt thoracic injury often leads to pulmonary contusion and the development of acute respiratory distress syndrome, which carries a high risk of morbidity and mortality, originating from the local and systemic inflammatory states. This study aimed to investigate the local and systemic antiinflammatory effects of levosimendan in rat models of blunt chest trauma.METHODS: A total of 32 Wistar albino rats were randomly assigned to one of the following four groups: control, sham, low-dose levosimendan (LDL) (5 µg/kg loading dose for 10 min and 0.05 µg/kg/min intravenous infusion), and high-dose levosimendan (HDL) (10 µg/kg loading dose for 10 min and 0.1 µg/kg/min intravenous infusion). Blunt chest trauma was induced, and after 6 h, the contused pulmonary tissues were histopathologically and immunohistopathologically evaluated, serum TNF-?, IL-1?, IL-6, and NO levels were biochemically evaluated.RESULTS: The mean arterial pressure was low throughout the experiment in the LDL and HDL groups, with no statistically difference between the groups. Levosimendan reduced the alveolar congestion and hemorrhage, which developed after inducing trauma. Neutrophil infiltration to the damaged pulmonary tissue was also reduced in both the LDL and HDL groups. In rats in which pulmonary contusion (PC) was observed, increased activation of nuclear factor kappa B was observed in the pulmonary tissue, and levosimendan did not reduce this activation. Both high and low doses of levosimendan reduced serum IL-1? levels, and high doses of levosimendan reduced IL-6 and NO levels. TNF-? levels were not reduced.CONCLUSION: In conclusion, the results showed that in a rat model of PC, the experimental agent levosimendan could reduce neutrophil cell infiltration to damaged pulmonary tissues and the systemic expressions of some cytokines (IL-1?, IL-6, and NO), thereby partially reducing and/or correcting pulmonary damage. Systemic inflammatory response that occurs after trauma could also be reducedÖğe Multiple Sklerozlu Gebede Anestezi Yönetimi(Kırıkkale Üniversitesi, 2016) Çolak, Yusuf; Yaman, FerdaMultiple skleroz (MS), genetik faktörlerin de önemli oranda rol aldığı çoğunlukla kadın hastaların etkilendiği yaygın olarak gözlenmekte olan santral sinir sisteminin immun-demiyenilizan hastalığıdır. Stress, cerrahi, anestezi, emosyonel sıkıntı, vücut ısısı değişiklikleri MS semptomlarında artmaya ve remisyondaki hastada yeni ataklara yol açabilir. Gebelik döneminde son trimesterda regresyon gösterdiği bununla birlikte gebelikten sonraki 3 ayda atakların belirgin arttığı bilinmektedir. Spinal anestezi, olasılıkla lokal anesteziklerin demiyelinizan nöronlara karşı artmış nörotoksik etkilerine bağlı olarak hastalığın postoperatif alevlenmesi neden olur. MS’de nöral dokudaki demiyelinizasyon spinal kordu lokal anesteziklerin histotoksik etkisine daha hassas hale getirir, bu yüzden spinal anestezinin kontrendike olduğunu bildiren yayınlar mevcutken spinal ve epidural anestezinin rölatif kontrendikasyon oluşturduğunu bildiren yayınlar da mevcuttur. Genel anestezi uygulamalarında kas gevşetici ilaçlar dikkatli kullanılmalıdır. Bu olguda elektif koşullarda sezaryen operasyonu planlanmış 26 yaşında MS hastası 38 haftalık nullipar gebe ve anestezik yaklaşımı literatür eşliğinde sunmayı amaçladık. Hastaya ameliyat, anestezi yöntemi ve riskler açıklandıktan sonra genel anestezi uygulamasına karar verildi. Kas gevşeticisiz entübasyon planlanmış olup propofole bağlı şiddetli ve yaygın myoklonik kasılmalar gözlenmiş olan olguda düşük doz kas gevşetici uygulanarak komplikasyonsuz entübasyon gerçekleştirildi. Anestezi idamesi sevofluran beraberinde remifentanil infüzyon ile sağlandı. Hastanın vücut ısı monitorizasyonu postoperatif 24 saat boyunca takip edildi. Postoperatif 4 hafta boyunca MS atak benzeri semptomlara rastlanmadı.Öğe Preoperative and post-operative sleep quality evaluation in rotator cuff tear patients(Springer, 2017) Serbest, Sancar; Tiftikci, Ugur; Askin, Aydogan; Yaman, Ferda; Alpua, MuratThe aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair. Thirty-one patients who underwent rotator cuff repair prospectively completed the Pittsburgh Sleep Quality Index, the Western Ontario Rotator Cuff Index, and the Constant and Murley shoulder scores before surgery and at 6 months after surgery. Preoperative demographic, clinical, and radiologic parameters were also evaluated. The study analysed 31 patients with a median age of 61 years. There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions (p < 0.001). A statistically significant improvement was determined by the Western Ontario Rotator Cuff Scale and the Constant and Murley shoulder scores (p E, 0.001). Sleep disorders are commonly seen in patients with rotator cuff tear, and after repair, there is an increase in the quality of sleep with a parallel improvement in shoulder functions. However, no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality. It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life. IV.
